Rehabilitation and Return to Play for Shoulder Injuries in Athletes

Shoulder injuries are prevalent in sports, particularly among young male athletes, and they present a significant challenge in returning to previous levels of performance. Research by the National Collegiate Athletic Association (NCAA) reveals that up to 30% of overhead athletes, and a staggering 67% of swimmers, suffer from shoulder injuries during their collegiate careers. The results emphasised that shoulder injuries often result from deficits in strength and motor control in the glenohumeral and scapulothoracic joints. This article summarizes postoperative care, return to play (RTP) criteria, and timelines for overhead athletes recovering from common upper extremity injuries.

Rehabilitation Phases:

  1. Acute Phase: This phase focuses on restoring range of motion (ROM), strength, endurance, and proprioception. Rest and protection are followed by the gradual restoration of near-normal passive ROM, which can take three to six weeks. The timeline depends on the type of injury and surgeon preference.
  2. Intermediate Phase: During this phase, athletes work on increasing strength, balance, and full active ROM in preparation for their sport. Closed chain weight-bearing, core exercises, and isotonic push/pull exercises are introduced. Special attention is given to shoulder external rotators and periscapular musculature.
  3. Advanced Phase: Athletes transition to advanced exercises as they approach near-full pain-free ROM and strength. Plyometrics play a crucial role in preparing for throwing, beginning with two-handed drills and progressing to one-arm drills with weighted balls.
  4. Return to Activity Phase: This phase involves a gradual increase in throwing fitness, including indoor reactive and weighted ball throwing. Throwing volume and intensity are increased gradually, with one day of rest recommended between throwing days.

However, it’s important to note that there’s no one-size-fits-all approach. Exercise selection should be tailored to the athlete’s specific deficits and needs, evolving from basic to advanced exercises as they progress.

Return to Play: Athletes can return to play after regaining full pain-free shoulder ROM, pre-injury strength, and passing clinical and sport-specific testing. RTP is a longer process with the involvement of sport coaches, allowing athletes to work back into full participation at their discretion.

Outcomes: Professional level throwers often struggle to reach pre-surgical performance levels. In contrast, non-overhead thrower recreational athletes (swimmers, crossfit athletes, rock climbers) tend to return successfully. Return-to-play rates for various shoulder surgeries vary, with non-throwing athletes showing more favorable outcomes than elite overhead athletes.

In conclusion, shoulder injuries are common in sports, and rehabilitation is a stepwise process tailored to individual needs. The return to play is influenced by the type of sport and the level of the athlete, with non-elite throwers having better outcomes. Rehabilitation programs should consider the unique demands of the shoulder and be patient-focused, gradually working athletes back into their sports.

If you are suffering from shoulder injury or recovery from shoulder surgery, book a consult with one of our clinicians who can guide you with a safe return to sport plan.


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