Turning our attention towards dual tasking in shoulder instability rehabilitation

Shoulder dislocations present a significant challenge to the global health system. With an unacceptable recurrence rate of 39% in the first year after first-time traumatic anterior shoulder dislocation, advancing shoulder instability management remains crucial.1 Currently, it is recommended that non-surgical management of shoulder instability should include immobilisation, exercises focusing on range of motion, progressive strength, motor control and rate of force development, and sport-specifics and psychological readiness.2 This editorial proposes the addition of dual tasking to typical non-operative management as a means of enhancing its efficacy. Dual tasking, or ‘divided attention’, describes the ability to simultaneously provide attention to or switch between two or more stimuli.3 The limited resource theory of divided attention implies that only a single pool of attentional resources is divided among competing stimuli, directly influencing sensorimotor integration and task performance.3 This supports the inclusion of dual tasking in rehabilitation, with the hypothesis that athletes who are more competent at performing motor tasks while simultaneously attending to stimuli in their environment may have improved outcomes, such as reduced risk of injury.4 To date, the traditional non-surgical management of shoulder instability has been built around strength-based rehabilitation, secondary to clinical reasoning in physiotherapy tending to follow a biomedical framework of pursuing an observable objective deficit with a corrective intervention.5 This objective lens would assume that strength and function after shoulder instability are correlated in a somewhat linear fashion. However, in the case of shoulder instability, …