Part of Rugby injuries: where they come from and which ones matter
Rugby shoulder dislocation: will it happen again, and do I need surgery
Warning signs, and when to get help
How a shoulder comes out in a tackle
Usually with the arm out to the side and turned backward, which is the position a tackle finds for you whether you asked for it or not. Going in with the arm reaching, taking a ball carrier whose momentum twists your arm back, landing on an outstretched hand, or having an opponent fall across the arm while it is pinned: all of them push the ball of the joint forward off the front of the socket. That is why the front of the shoulder is where most of these injuries happen and why the position returns every time you tackle.
Start with the club game, because that is the level most readers play at. In adult English community rugby between 2009 and 2013, 254 time loss shoulder injuries were recorded in match play at an overall incidence of 2.2 per 1000 hours, with a confidence interval of 1.9 to 2.4, and a mean of 9.5 weeks missed per injury, with a confidence interval of 8.2 to 10.8. Semi professional players were injured more often than recreational players, 2.8 against 1.8 per 1000 hours, back row forwards had the highest rate of any position at 2.9 per 1000 hours, and the tackle was the main event behind them (Singh and colleagues, 2016). That is every shoulder injury and not dislocations alone, so read the nine and a half weeks as the cost of a shoulder injury in the club game, not as the recovery time for this one.
Not every sore shoulder after contact is this injury. A fall straight onto the point of the shoulder with a tender lump on top is usually AC joint sprain, and an ache that builds with lifting and overhead work rather than arriving in one moment is more often rotator cuff tendinopathy. A dead arm that went numb or weak for a minute or two after a hit to the shoulder or neck, then came back, is a different thing again, and it belongs on the rugby neck injury page.
Will it happen again if I keep playing?
The strongest answer anyone has measured is about your age, not your sport. Across 10 studies and 1,324 adults with a first traumatic anterior dislocation, 39 percent went on to further instability, with higher risk in those aged 40 and under, in men, and in people with naturally loose joints (Olds and colleagues, 2015). In under 18s, six retrospective cohort studies put further instability at 73 percent overall, and separated 14 to 18 year olds from children of 13 and under at 93 percent against 40 percent, on evidence the authors themselves grade as a mix of acceptable and poor quality (Olds and colleagues, 2016). Most of the people who read a page like this sit inside those higher risk groups.
Rugby does not add a different percentage. It adds a different exposure. Going back to rugby means going back to the tackle, which means going back to the arm position the shoulder came out in, several times a match, for as long as you keep playing. No study has measured how much that raises the odds compared with a reader who dislocated a shoulder on a ski slope and does not ski again, so the page will not put a number on it.
The general figures for recurrence without surgery, the sling question and the four stage program all sit on dislocated shoulder exercises and physiotherapy, and that page is where to go for what to do next week. This page is about the decision on top of it.
Do I need surgery, and which operation?
The sport has two retrospective series of its own in rugby players, and they answer different questions. The first followed 62 competitive rugby players for at least five years after an open stabilization, 32 with an open Bankart repair and 30 players with 31 shoulders after an open Latarjet. Further dislocation happened in 18.8 percent of the Bankart group at a mean of 6.9 years and 3.3 percent of the Latarjet group at a mean of 6.2 years, 97 percent and 90 percent returned to rugby at the same level or higher at a mean of 8 and 6.3 months, and radiographic osteoarthritis was reported in 68 percent against 38 percent (Bonnevialle and colleagues, 2023).
The second is the argument for keeping the operation smaller. In 113 shoulders in 100 rugby or American football players, mean age 20, arthroscopic soft tissue stabilization with selective augmentation produced 4 further dislocations, 3.5 percent, at a mean follow up of 44 months (Hoshika and colleagues, 2021). A low figure from a specialist center in a case series is promising, not general.
Those numbers carry limits with them. Both series are observational, one level 3 evidence and the other level 4, and nobody randomized a player to either operation, so every comparison here is between groups a surgeon chose and not groups chance allocated. Inside the first series the two operations were compared directly, and the authors concluded that the open Latarjet outperformed the open Bankart repair on stability, on time back to play and on what the X-rays showed years later. The second is a case series with no comparison group at all, so its 3.5 percent and the first series' 3.3 percent are not two runners in one race: the follow up was 44 months against more than six years, recurrence keeps accumulating over that gap, and shoulders that needed a bony procedure were excluded from it, which takes out the ones a surgeon worries about most.
The osteoarthritis figures run the opposite way to the one most players expect. The 68 percent was the open Bankart group, the smaller operation, against 38 percent after the Latarjet, and 23 percent had moderate changes, all of them in the Bankart group. Read them for what they are: findings on an X-ray, in a cohort whose shoulder scores were no different between the two groups at that follow up. A change on film at six or seven years is not yet a symptom, and nobody has followed these players to the age at which it might become one.
What the rugby series cannot show you is the bill on the other side of the bone block. Across 45 studies and 1,904 shoulders of Bristow and Latarjet procedures, mean age 25.8 and mean follow up 6.8 years, the total complication rate was 30 percent and nearly 7 percent needed an unplanned second operation (Griesser and colleagues, 2013). The UK pathway puts it at 25 to 30 percent, with failure of the bone block to unite, nerve injury, recurrence and infection making up most of that, and says plainly that an open Latarjet should not be used routinely as a first operation when no bone has been lost from the socket, because of those risks and because the soft tissue repairs do well (Brownson and colleagues, 2015). In the rugby series itself, the only two second operations were in the Latarjet group, one infection and one hematoma, and the Bankart group had no complications at all (Bonnevialle and colleagues, 2023). The lower recurrence rate is bought, and what it is bought with is the thing to ask about.
Why do two surgeons give me two answers?
Because they genuinely disagree, and somebody has measured it. Ninety-seven surgeons from the American Shoulder and Elbow Surgeons and the British Elbow and Shoulder Society were surveyed about anterior glenohumeral instability in rugby players. Their treatment after a first dislocation differed significantly between the two groups, their immobilization periods differed, and their timing of return to play after arthroscopic stabilization and after open Bankart repair differed significantly, with the British surgeons more confident about allowing an earlier return (Moore, Hurley and Mullett, 2021). Where they did not differ is worth knowing too: treatment of a shoulder that had come out more than once, and the timing of return after a Latarjet, came out much the same in both groups.
That is a survey, so it describes opinion and not outcome, and 97 surgeons is a small slice of two large societies. It still helps to know before you see a second surgeon. Getting two different answers in the same week does not mean one of them is wrong or that somebody is guessing: it means you have walked into a documented disagreement inside the specialty, in a population where the trials have not been done.
The useful response is to ask each of them the same four questions. How much bone has gone from the socket on my scan, what does that rule in or out, what are you expecting of this shoulder in a tackle, and what does your plan trade against what the other plan trades. Written down, those answers usually explain the difference.
On that first question, do not expect a number you can look up and check your own scan against. The UK pathway treats a loss of about 20 percent of the socket surface as the point at which the risk of the shoulder coming out again climbs and a bone block enters the conversation (Brownson and colleagues, 2015). A cohort of 72 patients of mean age 26 in a military population with high physical demands found function already worse above 13.5 percent, even in the shoulders that never came out again, and its authors argued the critical figure should be lower than the 20 to 25 percent usually quoted (Shaha and colleagues, 2015). How the defect is measured changes the answer as well, which is why this page gives you the question and not a threshold.
What about going back without an operation?
Plenty of players do. It is not a mistake, just a decision with a known downside. The recurrence figures above describe exactly that group: a high proportion of young men go on to further instability without surgery, and each further dislocation is another episode of pain, another few weeks out and, in the published series, another chance of damage that changes what the operation can later achieve.
One finding in that same review runs the other way, and it is the one worth holding on to while you wait. The rate of further instability fell as the time since the first dislocation increased (Olds and colleagues, 2015). That is an observation about elapsed time and not a measure of what rehab achieved, and the same review graded the evidence on physiotherapy treatment as weak. It is still a reason not to rush back, and not to treat the weeks before your return as dead time. The work done in them is the part of this you control.
A physiotherapy program in that situation aims at strength and control of the muscles that hold the ball centered in the socket and the shoulder blade steady under load, plus a sense of where the joint is when you cannot see it. The staged version of that work is on dislocated shoulder exercises and physiotherapy, and its limit is blunt: no amount of cuff strength changes the shape of a socket that has lost bone. That is a reason to get the scan read, not a reason to stop the rehab, because the rehab is what gets the arm working whichever way the decision goes.
Tell your physio exactly which position brings on the feeling that the shoulder might go, and in which part of the game. The position tells a clinician more than the feeling does, and it is also what the return to sport test battery is built to test before anybody clears you for contact.
When to see a physio or a surgeon
A shoulder that has come out once and settled still needs an assessment, because what happens next depends on your age, your scan and your position. A shoulder that has come out more than once needs a surgical opinion alongside the rehab rather than instead of it. And a shoulder that feels as though it is slipping during ordinary training, or that has started to feel unreliable overhead, has told you something that a page cannot assess.
Some things need medical advice the same day and not an appointment: an arm you cannot lift properly since the dislocation, a numb patch or weakness in the arm or hand, a shoulder that is hot, red and swollen or comes with a fever, and numbness or weakness that is new since a stabilization operation. If a numb patch or a weak arm is no better by about 6 weeks, ask for a review rather than waiting it out, because that is when the UK pathway asks for a nerve test. Those are all in the warning list below in full, with what to say when you call. A shoulder that is out of place now goes to an emergency department, and nobody on the touchline should try to put it back.
One group should read the recurrence figures above the other way round. Over 40 a repeat dislocation becomes less likely, while a torn rotator cuff tendon or a stretched nerve becomes more likely, which is why the British Elbow and Shoulder Society and British Orthopaedic Association pathway asks for the cuff to be checked by ultrasound or MRI in anyone over 40 after a traumatic dislocation, with urgent referral if any doubt remains about whether it is torn. So the low recurrence risk is not the part to be reassured by: say how old you are when you call, and say that the arm has been weak since it happened.
If you are recovering from stabilization surgery, your surgeon's protocol comes before everything here, including the timings quoted from the published series. This page carries no post-operative program and no week by week plan on purpose: those belong to the team that did the operation. Expect to be seen by them, too. The UK pathway expects up to three outpatient appointments over at least 3 months after instability surgery, and more than that if the operation was complex or symptoms persist (Brownson and colleagues, 2015, as corrected in 2016). Nothing on a page substitutes for any part of that.
The rest of this hub covers the other two injuries that bring players in, rugby hamstring injury and rugby neck injury, the rules on getting back into contact at rugby return to play, and where the sport's injuries come from at rugby injuries.
Related exercise programs
Warning signs
Get emergency help now
- Emergency: a player who has gone down in contact has pain down the middle of the neck or back, numbness, tingling, burning or weakness in the arms or legs, limbs that feel heavy, a neck or back that looks out of shape, or trouble breathing. Treat it as a neck injury in the same way if the player has been knocked out, or has any injury above the collarbone, because somebody who is not fully awake cannot tell you their neck hurts. Do not move the player, and do not let anybody roll them onto their side. Call emergency services, keep the head and neck as still as possible, and wait for emergency healthcare professionals with spinal care training to move them, which is what World Rugby's own immediate care and first aid course material instructs. If you are not sure whether the neck is injured, treat it as though it is. If the player is not breathing, cannot keep their airway clear, for example because there is blood or vomit in their mouth, or you cannot be sure whether the airway is open and they are breathing, that comes first, and the emergency call handler will tell you what to do.
- Emergency: if chest pain, pressure or tightness does not ease quickly when you rest, spreads to your arm, neck, jaw, stomach or back, or comes with sweating, feeling sick, feeling light-headed or being short of breath, call emergency services straight away, as this can be a heart attack. If it eases quickly and none of these happen, get medical advice the same day, and do not exercise again until you have been checked.
- Emergency: chest pain or tightness, which may spread to your arm, neck or jaw, or shoulder or arm pain that comes with shortness of breath, sweating or feeling sick. This can be a heart attack. Call emergency services straight away.
- Emergency: your shoulder comes out again or stays out, feels as if it has slipped out of place, looks a different shape or suddenly locks so you cannot move the arm, or the pain is severe after a fall or an injury. Go to an emergency department straight away, without driving yourself, and call emergency services if you cannot get there. Do not try to put the shoulder back in yourself, and do not let a friend or teammate try.
- Emergency: your arm, hand or fingers turn cold, pale, blue or gray compared with the other side, or a swelling in your armpit keeps getting bigger. Call emergency services or go to an emergency department straight away, and do not drive yourself. The blood supply to the arm may be blocked.
- Emergency: if you faint while exercising, call emergency services, even if you feel fine again quickly.
- Emergency: any sign of a stroke, even if it goes away. That means a face that droops on one side, an arm you cannot lift or keep up, slurred or muddled speech, weakness or numbness on one side of your body or face, sudden blurred vision, double vision or loss of sight, trouble swallowing, sudden dizziness with unsteadiness or falling over, a sudden severe headache, or a sudden fall where your legs give way but you do not black out (a drop attack). Call emergency services straight away.
- Emergency: after a knock to the head, being very drowsy or finding it hard to keep your eyes open, confusion, a fit (seizure), new weakness or numbness anywhere in your body, new trouble understanding, speaking, walking or keeping your balance, new problems seeing or hearing, clear fluid coming from your ears or nose, bleeding from your ears or bruising behind them, a black eye when your eye was not hit, a dent in your head or a wound with something stuck in it, or a change in behavior. Call emergency services straight away. These can be signs of an injury to the brain.
- Emergency: after a knock to the head, you were knocked out, even for a moment, you cannot remember what happened just before or after, you have had a headache ever since, or you are being sick (vomiting). The same applies, even if you feel fine, if you take medicine that thins your blood, other than aspirin on its own, have a bleeding or clotting condition, have had brain surgery in the past, or had been drinking alcohol or taking drugs when it happened. Go to an emergency department straight away, and do not drive yourself.
- Emergency: severe neck pain after a knock to the head, whatever the fall or the knock was like. Keep still and call emergency services, and do not let anyone move you until someone trained has checked your neck. If the neck pain only starts later and nobody has checked your neck since, go to an emergency department straight away, and do not drive yourself.
- Emergency: after a knock to the head, swelling, a deep cut or severe pain at the exact spot that was hit. Call emergency services or go to an emergency department straight away, and do not drive yourself. These can be signs of a broken skull.
- Emergency: new problems walking, for example your legs feel stiff, heavy or weak or you have become unsteady on your feet, new trouble controlling your bladder or bowels, or hands that suddenly become clumsy, for example you can no longer do up buttons. Call emergency services straight away. These can be signs of pressure on the spinal cord in the neck.
- Emergency: after a ball, a boot, a hand or elbow, a collision or a fall to the face, any change to your sight, severe pain in the eye, a headache or finding light hard to bear, feeling sick or being sick, an eye you cannot move or keep open, or blood or pus coming from the eye. The same applies if something has pierced the eye or hit it at high speed, or if a strong chemical has gone into it. Go to an emergency department or call emergency services straight away, and do not drive yourself.
Get help today
- Same day: you have had a knock to the head and you take aspirin on its own, without any of the emergency signs above. Get medical advice the same day. Aspirin on its own is the only blood thinning medicine left out of the emergency line above, and the NHS still asks anybody taking a medicine that thins the blood to get urgent advice after a head injury.
- Same day: you cannot lift your arm properly after the dislocation, at any age, for example you cannot raise it out to the side or hold it up. This can be a torn rotator cuff tendon or a nerve injury, and both get more likely as you get older. Get medical advice the same day, say that the arm has been weak since the dislocation, and ask whether you need a scan, because UK shoulder surgeons advise urgent referral for a rotator cuff tear caused by an injury, and the British Elbow and Shoulder Society and British Orthopaedic Association pathway says anyone over 40 should have the cuff checked by ultrasound or MRI after a traumatic dislocation, and asks for urgent referral if any doubt remains about whether the cuff is torn (Brownson and colleagues, 2015).
- Same day: numbness, pins and needles or weakness in the arm or hand, especially a numb patch on the outer side of the upper arm or trouble lifting the arm out to the side. This can mean a nerve was stretched when the shoulder came out, such as the nerve to the muscle on the outside of the shoulder (axillary nerve). Get medical advice the same day. If one side of your face or body suddenly goes numb or weak, or your speech becomes slurred or muddled, call emergency services, even if it goes away.
- Same day: pins and needles in an arm together with neck or arm pain, or an arm that feels heavy or weak, and nobody has checked it yet. Get medical advice the same day. If it came on in contact and the symptoms are still there, or this is the first time it has happened, follow the first line in this list instead and get help at the ground, because World Rugby's own course material treats that player as a possible neck injury.
- Same day: the shoulder is hot, red and swollen, or you have a fever or feel unwell. This can be a joint infection, which needs treatment quickly. Go to an emergency department the same day, and call emergency services if you feel very unwell.
- Same day: since your operation, your wound becomes more red, hot, swollen or painful, starts to leak or ooze, is still leaking in the second week or has never stopped, has pus coming out of it or its edges start to come apart, or you have a high temperature or feel hot, cold or shivery. Contact your surgical team or get medical advice the same day. Redness can be harder to see on brown or black skin. If you feel very unwell, go to an emergency department. If you have a very high or very low temperature, shivering you cannot control, you are breathing very fast or finding it hard to breathe, you are confused or your speech is slurred, your skin, lips or tongue look blue, gray, pale or blotchy (on brown or black skin this can be easier to see on the palms of the hands or soles of the feet), or you have a rash that does not fade when you press it, call emergency services, as this can be sepsis.
- Same day: since your shoulder operation, new or worsening numbness, pins and needles or weakness in the arm or hand. Get medical advice the same day and tell your surgical team, because a nerve can be stretched or bruised during these operations, and your team decides whether it needs testing rather than you waiting at home.
- Same day: the pain is there at night or at rest and keeps getting worse. If you are being treated for cancer now, contact your cancer team the same day.
Book an appointment
- Within a day or two: the pain is there at night or at rest and keeps getting worse. If you have had cancer, now or in the past, or are losing weight without trying, see your doctor sooner, within a day or two, and mention it. This applies even if the pain is not getting worse.
- Within a few days: the pain is there at night or at rest and keeps getting worse. See your doctor within a few days.
- A numb patch on the arm, or weakness in the arm or hand, that is no better by about 6 weeks after the dislocation. Ask for a review with your shoulder team or your doctor rather than waiting it out, because the British Elbow and Shoulder Society and British Orthopaedic Association pathway advises a nerve test (EMG) at 6 weeks when a nerve injury has not started to recover, and referral to a nerve injury centre if that test shows no recovery either (Brownson and colleagues, 2015).
Common questions
Will my shoulder come out again if I keep playing rugby?
Age at the first dislocation is the strongest thing anyone has measured, and it is not about the sport. Pooling 10 studies and 1,324 adults who had a first traumatic anterior dislocation, 39 percent went on to further instability, and the risk was higher in people aged 40 and under, with an odds ratio of 13.46, in men, at 3.18, and in those with naturally loose joints, at 2.68 (Olds and colleagues, 2015). In under 18s the figures are higher again: across six retrospective cohort studies, 73 percent had further instability, and 14 to 18 year olds were far more likely to than children of 13 and under, 93 percent against 40 percent (Olds and colleagues, 2016). The authors of that second review describe their own included studies as a mix of acceptable and poor quality, so the direction is more reliable than the exact percentages. The general picture, including what happens with physiotherapy alone, is set out on dislocated shoulder exercises and physiotherapy; what rugby adds is that the sport keeps presenting the arm with the position the shoulder came out in.
Do I need surgery after a rugby shoulder dislocation?
That is a conversation with a shoulder surgeon, from your own scan, and the published rugby evidence can inform it without settling it. Two retrospective series are the sport's own: in 62 competitive rugby players followed at least five years, further dislocation happened in 18.8 percent after open Bankart repair and 3.3 percent after open Latarjet, with 97 percent and 90 percent getting back to rugby at the same level or higher at a mean of 8 and 6.3 months, and radiographic osteoarthritis in 68 percent and 38 percent (Bonnevialle and colleagues, 2023). In 113 shoulders in 100 rugby or American football players of mean age 20, arthroscopic soft tissue stabilization with selective augmentation gave 4 further dislocations, 3.5 percent, at a mean of 44 months (Hoshika and colleagues, 2021). Neither is a trial, and the two studies cannot be read against each other, because only the first compared two operations and the second has no comparison group at all. Two things a 22 year old is rarely told: the osteoarthritis was commonest after the smaller operation, 68 percent, and it was an X-ray finding in a group whose shoulder scores were no different; and the bone block carries a complication rate around 30 percent, with nearly 7 percent needing an unplanned second operation (Griesser and colleagues, 2013). What the surgeon is weighing on top of all that is how much bone has been lost from the socket, which only imaging can tell you.
How long until I can play rugby again?
A date is the wrong unit, and the published ones are means from operated players in specialist centers. In the long term rugby series above, players returned at a mean of 8 months after open Bankart repair and 6.3 months after open Latarjet (Bonnevialle and colleagues, 2023). For the ordinary shoulder injury in the club game the figure is different again, because it covers every shoulder injury rather than just dislocations: in adult English community rugby, 254 time loss shoulder injuries over four seasons cost a mean of 9.5 weeks, with a confidence interval of 8.2 to 10.8 (Singh and colleagues, 2016). Those are averages across a population, and a surgeon's protocol, your own strength and the position you play are what decide yours. The return to sport test battery sets out the tests clinicians use instead of a calendar.
Can I play rugby in a shoulder brace?
We could not find readable evidence that answers this for rugby, and saying so is more use than a guess. None of the rugby specific studies on this page tested a brace, and no randomized trial of shoulder bracing in collision sport turned up in the searching behind this page. In practice it is a decision between you, your surgeon and your physio, based on your scan and what your shoulder does in the position your sport puts it in, rather than something a page can recommend or rule out. Ask specifically whether a brace changes what your repair is being asked to take, because that is a surgical question rather than a comfort one.
References
- World Rugby Passport. First Aid in Rugby, Chapter 5: Neck and spinal injuries in Rugby Union. https://passport.world.rugby/player-welfare-medical/first-aid-in-rugby/chapter-5-neck-and-spinal-injuries-in-rugby-union/
- World Rugby Passport. Immediate Care in Rugby, Spinal Injuries: recognition, assessment and management. https://passport.world.rugby/player-welfare-medical/immediate-care-in-rugby/spinal-injuries/recognition/
- Olds M, Ellis R, Donaldson K, Parmar P, Kersten P. Risk factors which predispose first-time traumatic anterior shoulder dislocations to recurrent instability in adults: a systematic review and meta-analysis. British Journal of Sports Medicine. 2015;49(14):913-922. https://doi.org/10.1136/bjsports-2014-094342
- Olds M, Donaldson K, Ellis R, Kersten P. In children 18 years and under, what promotes recurrent shoulder instability after traumatic anterior shoulder dislocation? A systematic review and meta-analysis of risk factors. British Journal of Sports Medicine. 2016;50(18):1135-1141. https://doi.org/10.1136/bjsports-2015-095149
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- Hoshika S, Sugaya H, Takahashi N, Matsuki K, Tokai M, Morioka T, Ueda Y, Hamada H, Takeuchi Y. Arthroscopic Soft Tissue Stabilization With Selective Augmentations for Traumatic Anterior Shoulder Instability in Competitive Collision Athletes. American Journal of Sports Medicine. 2021;49(6):1604-1611. https://doi.org/10.1177/03635465211003091
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- Griesser MJ, Harris JD, McCoy BW, Hussain WM, Jones MH, Bishop JY, Miniaci A. Complications and re-operations after Bristow-Latarjet shoulder stabilization: a systematic review. Journal of Shoulder and Elbow Surgery. 2013;22(2):286-292. https://doi.org/10.1016/j.jse.2012.09.009
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- Singh VR, Trewartha G, Roberts SP, England M, Stokes KA. Shoulder Injuries in English Community Rugby Union. International Journal of Sports Medicine. 2016;37(8):659-664. https://doi.org/10.1055/s-0042-104414
- West SW, Starling L, Kemp S, Williams S, Cross M, Taylor A, Brooks JHM, Stokes KA. Trends in match injury risk in professional male rugby union: a 16-season review of 10 851 match injuries in the English Premiership (2002-2019): the Professional Rugby Injury Surveillance Project. British Journal of Sports Medicine. 2021;55(12):676-682. https://doi.org/10.1136/bjsports-2020-102529
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Written and checked by the PocketPhysio editorial team. Last updated 2026-11-06.
This page is general education, not a diagnosis or a personal treatment plan. See a physiotherapist or doctor for advice about your own situation.