What are the benefits and harms of exercise therapy for multidirectional instability of the shoulder (where the joint moves out of place in more than one direction)?

Key messages

• The benefits and harms of exercise therapy for multidirectional instability of the shoulder are currently unknown, as there is no evidence from randomised controlled trials (studies in which participants are assigned randomly to two or more treatment groups).

• Future studies need to be randomised trials that evaluate the benefits and harms of exercise therapy in people with multidirectional shoulder instability compared to a control group (a group of people who receive a placebo ('dummy' or sham treatment), no treatment, are put on a waiting list, or receive the usual treatment).

What is multidirectional instability of the shoulder?

The shoulder is a highly mobile joint that relies on muscles, ligaments, and joint capsules (the soft tissue envelope that surrounds and stabilises the joint) to maintain stability. Multidirectional instability occurs when the humeral head (ball of the shoulder joint) moves excessively in multiple directions due to weakened stabilising structures. This can lead to discomfort, pain, loosening, or instability of the shoulder. Multidirectional instability is often associated with joint laxity (looseness of the joint that allows it to move too much), which may be congenital (from birth) or develop through repeatedly moving the arm overhead during sports or other activities.

What does exercise therapy mean?

Exercise therapy is commonly recommended as the first treatment choice for people with multidirectional instability. It focusses on enhancing both the strength and recruitment of the rotator cuff (how well these muscles are activated and used) and scapular (large triangular shoulder bone) muscles to improve shoulder stability. Exercises may include resistance training, proprioceptive drills (exercises that help the body sense joint position and movement), and scapular movement correction. Experts believe that targeted exercises can help control excessive humeral head movement and improve functional stability. However, the benefits and harms of exercise therapy remain unclear.

What did we want to find out?

This review aimed to determine whether exercise therapy improves pain, shoulder instability, and quality of life in individuals with multidirectional instability, and whether it may cause any harms.

What did we do?

We searched for randomised studies in people with traumatic or nontraumatic (with or without a specific injury) multidirectional instability that assessed the benefits and harms of exercise therapy. The studies had to compare a group of people performing exercise therapy to a group that received a placebo intervention or a group that received no treatment, usual care, or were placed on a waiting list for treatment. We planned to compare and summarise the results of these studies and rate our confidence in the evidence, based on factors such as study methods and sizes.

What did we find?

We did not find any randomised controlled trials that assessed exercise therapy in people with multidirectional instability of the shoulder.

What are the limitations of the evidence?

We did not find any evidence from randomised controlled trials.

How up to date is this evidence?

We searched for studies up to May 2025.