AC Joint Injuries in Rugby League – Do You Need Surgery?

Have you copped a big hit in a tackle and now have sharp pain on the top of your shoulder? Does your shoulder feel unstable or sore when passing across your body, tackling, or lifting weights? If so, you might have injured your Acromioclavicular (AC) joint—a common injury in rugby league players due to the high-impact nature of the sport.

Many players assume that any shoulder injury means surgery, but the truth is that most AC joint cases can be successfully treated non-operatively with expert physiotherapy.

In fact, during my almost 10 years working in the NRL, not one player had surgery to repair an AC joint injury and all returned to playing within 6 weeks.

Let’s break down what AC joint injuries are, why they happen in rugby league, and how skilled manual therapy and rehab can get you back in the game—without surgery.

What is an AC Joint Injury?

The AC joint is where your collarbone (clavicle) meets the top of your shoulder blade (acromion). It acts as a key stabilizer for shoulder movement, especially in contact sports.

AC joint injuries occur when there is direct impact to the shoulder—typically from a heavy tackle, falling on the point of the shoulder, or a hard collision with the ground.

Types of AC Joint Injuries

🔹 Grade 1 (Mild Sprain): Slight stretching of the ligaments, minor pain, and little to no deformity.
🔹 Grade 2 (Moderate Sprain): Partial ligament tear, visible swelling, and discomfort with overhead movements.
🔹 Grade 3 (Severe Sprain/Separation): Full ligament rupture, visible bump at the top of the shoulder, and significant pain/weakness.

Grades 4-6 injuries (more severe displacements) are rarer and may require surgical consideration. However, Grades 1-3 are typically managed non-operatively with excellent results.

Do You Need Surgery for an AC Joint Injury?

In most cases, No! Studies show that non-operative management of Grade 1-3 AC joint injuries is just as effective as surgery for restoring strength, function, and long-term performance.

Here’s how expert physiotherapy can get you back on the field—without surgery.

1. Pain & Inflammation Management

✅ Early hands-on therapy to reduce swelling and irritation.
✅ Strapping/taping techniques to stabilise the joint and reduce pain in early rehab.
✅ Guided return-to-play strategies to prevent unnecessary rest or overload.

2. Manual Therapy for Joint Mobility & Muscle Balance

✅ AC joint injuries often cause stiffness and compensatory tightness in the upper traps, pecs, and rotator cuff.
✅ Targeted manual therapy techniques can improve joint movement and shoulder blade function for faster recovery.

3. Strength Training for Stability & Contact Resilience

✅ Strengthening the deltoids, rotator cuff, and scapular stabilizers restores shoulder function.
✅ Gradual progression of pressing, tackling, and overhead movements ensures safe return to contact.

✅ Pro Tip from the NRL: A landmine press or floor press are great ways to regain strength faster with less pain.

4. Gradual Return to Rugby League-Specific Movements

✅ Progressive loading of tackling, passing, and weightlifting movements ensures confidence before returning to play.
✅ Controlled exposure to contact drills helps prevent re-injury.

When Should You See a Physio?

If you’re dealing with an AC joint injury, don’t rush into surgery before considering a non-operative rehab plan.

With expert manual therapy and a structured return-to-play program, most rugby league players make a full recovery without surgery.

With almost 10 years in NRL rehab we can help you recover faster, stronger, and more confidently-learn more about Luke

Book an Appointment Today!

Don’t let an AC joint injury keep you off the field! Book an appointment today with our expert physiotherapists and start a non-surgical rehab plan that works. Click the ‘book now’ button below.