Anterior-Inferior GH Instability
Glenohumeral Instability
Protection → Controlled Motion → Return to Function
What Glenohumeral Instability Is
Instability is the opposite of impingement — it's a too-much-movement problem. The shoulder is a shallow ball-and-socket built for huge range, and that trade-off means the ball can slide too far in the socket. Anterior-inferior is by far the most common direction — the ball wants to slip forward and down, usually after a dislocation stretched or tore the tissues that normally hold it in.
- Primary — Traumatic — a dislocation or hard event stretched or tore the capsule and the labrum (the rim that deepens the socket), so the ball now translates too far. This shoulder is loose in one direction.
- Secondary — Atraumatic / multidirectional — the capsule is naturally loose and the shoulder is hypermobile in several directions, with no single injury to blame. This one needs control built from the ground up.
Involved tissues: The joint capsule and the glenohumeral ligaments and labrum (the static restraints that got stretched), plus the rotator cuff and scapular stabilizers — the dynamic restraints we train to hold the ball centered.
The two pillars of treating instability: first, this shoulder wants CONTROL, not more range — we stabilize what's loose, we don't stretch it. Second, the dynamic stabilizers do the holding — aggressively strengthening the rotator cuff and scapular stabilizers is THE priority. Two hard rules serve both: avoid anterior glide, and limit external rotation until control is solid.
Why control beats range here
With a loose shoulder, the static restraints (the stretched capsule and labrum) can't be tightened by exercise — so the job falls to the dynamic restraints: the rotator cuff centers the ball, and the scapular stabilizers set a stable platform behind it. That's why the whole plan is about building strength and reflexive control, and why we stay out of the provocative position — the arm up and rotated out (abduction + external rotation) — where an anterior-unstable shoulder feels like it might give way. Protect what's loose, strengthen what stabilizes it.
⚠️ Screen Before You Start — Get Assessed First If You Have:
- ●A shoulder that is currently dislocated or visibly deformed — do not try to move it, get seen now
- ●Numbness or a dead patch over the outer shoulder (possible axillary nerve involvement)
- ●A cold, pale, or pulseless hand after a dislocation
- ●Repeated dislocations or the shoulder giving way often
- ●Pain radiating below the elbow, or worsening week over week
This is education, not a diagnosis, and doesn't replace hands-on care.
🌡️ Finding your stage
Take your movement temperature before each session. With instability we're also reading security, not just pain: guarding or a feeling the shoulder might slip early in the range = Protection phase. Secure through mid-range but shaky as you approach end-range = Controlled Motion. Solid through range with control, only tested at the very end = Return to Function. Re-check every session — today's behavior sets the stage, not the calendar.
Phase 1 · Acute
Protection Phase
🌡️ Guarding · feels loose early in range · reactive tissue
Goal: Protect the stretched capsule and labrum, calm pain and swelling, and start gentle dynamic control — all WITHOUT going near the position where the shoulder feels like it might slip.
Manual treatment: Pain-relief modalities and gentle, protected passive motion strictly within a safe, non-provocative range.
Frequency: Daily as tolerated · short, secure, pain-free sessions.
A. Protect & Calm
SoftWave Therapy
Video coming soon- Dose
- As scheduled in clinic
- How
- Applied to the injured capsule and cuff to calm symptoms and stimulate the healing response without loading the joint.
- Watch for
- The anchor of the early phase — works on the tissue while you keep the shoulder protected.
Protect & Activity Modification
Video coming soon- Dose
- Ongoing
- How
- Relative rest (a sling early after a dislocation if advised), ice as needed, and modifying activity to stay out of the abduction-and-external-rotation position that feels unstable.
- Watch for
- The provocative position is arm up and rotated out (like a throwing cock-back). Avoid it entirely this phase.
Scapular Setting
Video coming soon- Dose
- Throughout the day
- How
- Gently set the shoulder blade down and back to build the stable platform the ball sits against. Low effort, no shrugging.
- Watch for
- A steady blade is the foundation of a stable shoulder — start waking it up immediately.
B. Gentle Activation — Open-Pack Isometrics
Sub-Max Cuff Isometrics in Open-Pack
Video coming soon- Dose
- 5-sec holds · 10 reps each · 20–30% effort
- How
- With the arm resting comfortably at the side (the loose-packed, safe position), press gently into external rotation, internal rotation, and abduction against your other hand or a wall.
- Watch for
- Gentle and secure. Keep the arm at your side — do NOT set up in the abduction-and-external-rotation position.
Protected Pain-Free Motion
Video coming soon- Dose
- 5–10 reps each safe plane
- How
- Move only through the range that feels completely secure, keeping external rotation limited and avoiding any end-range that feels loose.
- Watch for
- Instability isn't a stiffness problem — don't chase range. Stop at the first hint the shoulder feels unstable.
Protection-phase precaution: this shoulder is loose, not stiff — resist the urge to stretch it. Stay out of the apprehension position (arm abducted and externally rotated), avoid any anterior glide, and keep external rotation limited. The whole job right now is to protect what's loose while you start building control.
✅ Ready for the next phase when:
Pain and swelling settle, the arm feels more secure at rest, and the open-pack isometrics are strong and pain-free.
Tracking Your Progress
The weekly stability check: am I better, the same, or worse than last week?
Better
Stay the course; progress as the shoulder feels more secure and control holds at higher angles and speeds.
Same
Change something: the dose, the drill, or the intensity — but keep control the priority over range.
Worse
Drop back a phase, let it settle, reassess. Check you're not drifting into external rotation or the apprehension position.
The Rules That Govern This Protocol
- 1Instability wants control, not range — stabilize what's loose, don't stretch it.
- 2Avoid anterior glide and limit external rotation until dynamic control is solid.
- 3The universal rule: no lasting increase in pain — or apprehension — after a session.
Movement You Love Is Therapy. This protocol is general education based on course rehabilitation materials and standard principles. It is not medical advice, diagnosis, or treatment, and does not create a provider–patient relationship. If pain is severe, worsening, or unexplained, see a licensed provider.