Recurrent shoulder injuries in athletes can often be troublesome and difficult to treat. To date there is no consensus on specific return to play tests for the shoulder that indicate return to sport will be successful and not result in re-injury. This often creates a dilemma for physiotherapist as some guess work is often required when considering whether the athlete can return to sport. That being said, many athletes do fully recover from recurrent shoulder injuries but not always as quickly as they would have liked. Interestingly, it is what injured athletes have been doing with other parts of the body during rehabilitation which has given us insight into how important muscle strength and balance is in the rest of the body for the shoulder to perform at its best. 
Healthy shoulder function is not just dependent on what is happening around the joint but what the rest of the body is doing before and during shoulder activity. Recent studies have shown that only 20% of shoulder force production is produced by muscles around the shoulder and shoulder blade, the other 80% comes from the lower limbs and trunk. Given this finding it makes sense to consider the strength and ability to control movement of the trunk and lower limb musculature when dealing with a recurrent or even non recurrent shoulder injury. Muscle strength around the shoulder still remains important as it is required to be able to cope with transfer of the velocity of movement which is intially generated from the rest of the body. 
If you are suffering from recurrent shoulder injuries, despite repetitive attempts at rehabilitation, it may well be worth looking at whether there are defficiencies in the trunk or lower limb which are contributing to your overall force production during shoulder movements and skills. Your physiotherapist should be able to help you identify these deficits and provide advice on how these can be corrected.  
Craig Fowlie 
Senior Physiotherapist 
MSc (Sports and exercise med) Dist, BPHTY(Hons) 
Member of HCPC, MCSP 


Craig Fowlie 

Craig is a highly specialized physiotherapist with post graduate qualifications in Acupuncture and Sports and Exercise Medicine. 
He has worked with Professional Rugby sides in New Zealand and has assisted Great Britain Table Tennis at the World Team Championships and Olympic Qualifiers in Qatar and Germany. He is a consultant for the Governments Talented Athlete Scholarship Scheme and has published and presented research in the Journal of Physiotherapy and the Chartered Society of Physiotherapy Annual Conference. 
Outside of work he enjoys participating socially in triathlon and running. 
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