Shoulder Dislocation – Types and Treatments

By Michael Brezak, DPT – Hampton Physical Therapy, Hampton NH Clinic –

There are many different types of joints in the human body. Some are more fixated while others tend to have higher mobility. This of course comes at a cost as the joint with higher degrees of mobility can also experience more traumatic injuries. The shoulder joint is one such highly mobile joint that often times experiences various injuries from falling, sport related activities, or from repeated motions. The shoulder is classified as a ball-and-socket joint with almost a full 360 degrees in a plane of motion. To support this joint, it is encapsulated in a fibrous band of connective tissue and deepened with a ring of connective tissue known as a labrum. The joint is then stabilized further by a system of four muscles that also are the basis for movement called a rotator cuff (Supraspinatus, Infraspinatus, Teres Minor, and Subscapularis). When there is an excessive amount of force applied, the shoulder becomes displaced causing a dislocation either forwards or backwards that requires medical attention. This article aims to give insight on the three types of shoulder dislocations, treatment approach, and prognosis.

Anterior Shoulder Dislocation: This type of shoulder injury is whenever a blunt traumatic force is directed from behind the joint itself or from falling on an outstretched arm. This injury is usually the most common experienced resulting into upwards of 95% of shoulder dislocations. Determination is performed via X-ray diagnostics and presents with the individual holding their shoulder slightly away from their body.

Posterior Shoulder Dislocation: When a force is applied to the frontal aspect of shoulder, the ‘ball’ of the socket has a high chance to become displaced posteriorly. This type of dislocation is less common than an anterior dislocation, but can be more severe due to becoming lodged behind a bony prominence of the shoulder blade. This type of dislocation is usually the most common in the elderly.

Inferior Shoulder Dislocation: This type of dislocation is the least common of the various types. In this dislocation the joint is directed downward while the arm is rapidly forced upward. An example of this is falling from a height while the arm hits and object forcing it upward. While the least likely, this type of dislocation can be further complicated by compression of nerves and numerous blood vessels in the area.

What can physical therapy do?
Once you have received confirmation of your shoulder being dislocated, you may be placed into a shoulder sling to limit excessive movement and referred to physical therapy. Each patient receives patient focused goals based on their personal goals, but the aim is to restore functional, strength, and stability. Some initial exercises that can be performed at home without significant discomfort are found below:

Isometric pushes: Standing at a wall, place a soft pillow against the wall with your injured arm holding it in place. Your injured arm should be resting at your side with your elbow bent to 90 degrees. Push into the pillow with 50% intensity holding for 3 seconds, rest, repeat.

Scapular Squeezes: While standing or sitting, squeeze your shoulder blades together as if rowing a boat. Let your arms either hang at your side or have your elbows bent to 90 degrees simulating rowing a boat. Hold each squeeze for 3 seconds, rest, repeat.At Hampton Physical Therapy we apply the latest in research-based interventions to get patients back to their previous level of function in the shortest amount of time. We create rehab goals based on the patient’s interests/desires while improving on your ability to return to those activities. We have two locations in both Hampton and Seabrook to provide you with a level of care and service needed to get you back where you want to be. If you still have questions feel free to call either location or sign up for a FREE Discovery Visit and speak with a therapist to learn how physical therapy can help you.


  1. 1. Shoulder Dislocation-Harvard Health. Harvard Health Publishing-
  2. 2. Edmiston, Julie PA-C , RT. Distinguishing three types of shoulder dislocations. Journal of the American Academy of PAs. May 2013. 26:5. p 60, 62-63.

Dizziness & Vertigo ~ PT Can Help!

Hampton Physical Therapy treats Vertigo and Dizziness

By Lisa Wheldon, DPT, Hampton Physical Therapy – Seabrook NH Clinic

Have you ever rolled over in bed and suddenly the room starts spinning? Maybe you went to get your hair done at the salon and you tipped your head back in the sink and you became nauseated. Or every time you go to get up from laying down you feel like you might fall over. All of these events could be the result of a condition typically referred to as vertigo. Vertigo is defined as a sensation of whirling or movement that results in an error message in the central process of position, space, and time. So your brain can’t sense where you are in space causing you to feel dizzy. 20-30% of adults experience dizziness in their lifetime.1

Day after day I hear my patients mention that they can’t do a certain activity because they get light headed or nauseous. This doesn’t have to be the case. Physical therapy can evaluate and likely treat this condition when appropriate. 90% of the time this condition is caused by BPPV (Benign paroxysmal positional vertigo).2 BPPV is a condition that is most commonly seen with people over the age of 50.2 “Most often, BPPV occurs spontaneously, but it also may follow head trauma, neuritis affecting the superior vestibular nerve, or ischemia in the distribution of the anterior vestibular artery.”3 What happens occurs in the inner ear and it affects the vestibular system. This system is in charge of coordinating movement with where the body is in space. Inside the inner ear are crystals (otoconia) located in the canals (semicircular canals) and may become dislodged and throw off a person’s proprioception (sense of where they are in space). If this occurs the individual can have the feeling of the room spinning around them causing nausea, light headedness, and even potentially fall over!

Research has shown that vertigo treatment can be
87% effective in just three physical therapy treatments

At Hampton Physical Therapy, a full assessment can be performed to screen out what could possibly be causing your dizziness then direct you to the appropriate treatment. If we don’t feel you are appropriate for therapy we will direct you to correct line of treatment possibly involving neurology, cardiology, or your PCP. vertigo-manouverIf we do find that you test positive for BPVV through our testing maneuvers we can treat you that day. Treatment will involve different maneuvers to help re-position the crystals through the canals and go back into their proper place. After your treatment you will be instructed on proper at home care. A majority of the time your symptoms could be resolved in this first treatment. Could you imagine you’ve been suffering with this awful dizziness for years and in just one treatment your symptoms could be resolved or greatly reduced? Research has shown that treatment can be 87% effective in just three treatments.3

balanceAdditional treatments would typically include performing the maneuvers again if you are still suffering from unsteadiness. Also, different exercises can be done to improve balance and visual acuity. VOR (vestibular ocular reflex) exercises, balance training, and soft tissue or spinal manipulation treatment for muscular issues. VOR exercises include gaze stabilization exercises, balance retraining, and vestibular habituation. Gaze stabilization is done to help someone’s ability to stabilize, track, and pursue an object with their vision. This helps someone that may be motion sensitive. Balance retraining involves challenging how someone reacts to sitting or standing on different stable or unstable surfaces. Habituation involves upsetting the persons’ vestibular system and actually making them feel dizzy A comprehensive home exercise program is created for the individual to challenge their vestibular systems.

These exercises can also be useful in treatment with patients with post-concussion symptoms. After a head injury where someone loses consciousness this patient has a concussion. So there has been trauma and damage to the brain. Patients can suffer from an under active vestibular system Following this injury people can suffer from memory fog, vision issues, fatigue and just not feeling like themselves. It is recommended that for proper healing of the brain tissue they should abstain from their sport or typical activity level for 30 days.3 If symptoms persist for longer than 90 days the person falls under the post-concussion category.3 These patients can benefit from physical therapy.

If you are suffering from dizziness Hampton Physical Therapy is here to help. Call for an evaluation. When you call we recommend stopping any anti-dizziness medication for 24 hours prior to treatment in order to be properly screened.  We can get you scheduled ASAP, you should bring a driver for your safety.

Don’t suffer any longer when you can be seen in a matter of days and start living your life again!

1. Neuhuaser HK. The epidemiology of dizziness and vertigo. Handbook Clinical Neurology. 2016;137:67-82. doi: 10.1016/B978-0-444-63437-5.00005-4.
2. American Musculoskeletal Institute. Vestibular rehabilitation specialist handbook. 2017.
3. Herdman SJ. Benign Paroxysmal Positional Vertigo. April 2018.

Are Shin Splints Wrecking Your Run?

Physical Therapy Can Help!
By Jessica Leberman, DPT – Hampton Clinic

Medial Tibial Stress Syndrome (MTSS) more commonly referred to as “shin splints” is an injury of the lower leg that primary occurs in the exercising population1. MTSS makes up to 16% of injuries that occur in runners2. MTSS typically presents as pain along the lower 2/3rd of the tibia (shin) bone with activity. Often, the pain is worst immediately upon initiating exercise it then, however, eases as the exercise continues and subsides entirely once stopping exercise. The presentation can vary and as the condition worsens pain at rest can occur.3

What Causes Medial Tibial Stress Syndrome?

As the name indicates, MTSS is a repetitive overuse injury usually affecting runners, dancers and others that participate in athletic-related activities. The pathophysiology of MTSS is thought to be due to periostitis of the tibia that occurs when the tibia is placed under repetitive loading. Biomechanical faults within the lower leg such as specific calf and ankle muscle dysfunction can lead to over-loading/bending the tibia with exercise.3

overpronationRisk Factors of Medial Tibial Stress Syndrome3

  •    -Elevated Body Mass Index (BMI)
  •    -Abnormal ankle range of motion
  •    -Over pronation (flat feet)
  •    -Abnormal hip range of motion
  •    -Females > Males


Not all risk factors are completely controllable to prevent MTSS, therefore, it is important to control the factors that can be controlled such as;

  •    -Proper footwear for exercise
  •    -Slowly/gradually increasing exercise regimen
  •    -Avoiding running too much on hard and/or inclined surfaces

    stretch-leg-hpt(Dr Jessical Leberman treating a patient with shin splint pain)

How Physical Therapy Can Help

The focus of Physical Therapy for MTSS (shin splints) is multifactorial. Initially, soft tissue and joint mobilization manual techniques, stretching, and modalities will be used to reduce inflammation and pain levels and promote healing to the injured area. Guided strength work will be involved to reduce over loading through the tibia. Additionally, your physical therapist will assess foot mechanics to ensure proper footwear is worn to better improve force distribution during exercise. Lastly, your PT will help guide/modify your exercise/training regimen to ensure return to normal activity levels is done correctly to reduce risk of re-injury.3

Contact Hampton Physical Therapy or visit us at to learn more.

1. Winkelmann ZK, Anderson D, Games KE, Eberman LE. Risk Factors for Medial Tibial Stress Syndrome in Active Individuals: An Evidence-Based Review. J AthlTrain. 2016 Dec;51(12):1049-1052
2. Craig DI. Medial tibial stress syndrome: evidence-based prevention. J Athl Train. 2008 May-Jun;43(3):316-8.
3. Galbraith RM, Lavallee ME. Medial tibial stress syndrome: conservative treatment options. Curr Rev Musculoskelet Med. 2009 Oct 7;2(3):127-33.