5 Thorsness et al 6 has also illustrated that return to play outcomes are often poorly described when evaluating overhead athletes specifically.Īdvocacy for the use of subjective rating via the Numeric Pain Rating Scale (NPRS) or Visual Analog Scale (VAS), objective criteria, patient reported outcomes including those related to athlete confidence, and the successful performance of specific objective functional tests should be promoted by all sports physical therapists, in order to determine when an athlete is ready to begin practice and return to participation. Also of interest, those who performed rehabilitation for less than six months had a significant reinjury rate compared to those who performed physical therapy greater than six months, 23.1% and 9.6% respectively. This suggests that while the overall satisfaction was high, return to sport could have possibly been higher had a comprehensive criteria-based approach been utilized to determine cessation of rehabilitation. 5 No mention was made of functional testing or sport specific testing being assessed prior to discontinuing rehabilitation. 5 The cessation of rehabilitation was determined by presence of dyskinesia, subjective apprehension, and presence of range of motion deficits, or lack thereof. While the results of the study revealed a high rate of patient satisfaction at 92.3%, the return to sport at the same level was only 49.5%. This case series evaluated the results of 143 cases with an average follow up of 13.3 years. 4 However, recently Aboaloata et al 5 reported a return to the same level of sport at significantly lower rates in a study looking at the long term outcomes after arthroscopic Bankart repair for anterior-inferior shoulder instability. 4 Return to play was determined by range of motion, time from surgery (three months for non-contact and six months contact sports), and the Oxford Instability scores pre- and post-operatively. 3 Similarly a study assessing return to sport after arthroscopic shoulder plication for multidirectional instability reported a 90% return to the same level of play. 3 Return to sport was allowed once pain free range of motion and >80% of strength compared with the contralateral side was achieved. However, because of soft tissue healing constraints, it is also important to consider the temporal aspects, particularly following surgery.Īlentorn-Geli et al studied return to sport after arthroscopic shoulder capsulolabral repair and reported an 86% return to sport with 73% of the subjects returning to the same level of play. The recovery and return to play of an athlete after injury is a multifaceted clinical decision. The time from the injury itself is not the primary element that will determine readiness to return to practice or competition. Additionally, the use of time as the sole determination of when an athlete may resume practice or play following a shoulder injury or surgery is a critical error. Nothing is more demoralizing to an athlete, and produces a more problematic set back in the rehabilitation process than developing reactive symptoms when trying to resume athletic activity before an athlete is functionally ready and capable. While this answer may sound flippant, it is in fact very true. ![]() ![]() ![]() ![]() The simple answer is the athlete can resume athletic activity again when they are ready and not before. “When can I play again?” This is possibly the most frequently asked question by an athlete following any type of injury. This tremendous mobility makes returning to sport participation following a shoulder injury, whether non-operative or post-operative, contact or non-contact, a challenging task for both the clinician and the athlete. 2 The shoulder has the greatest range of motion of any joint in the human body. At the NFL combine 9.7% of athletes had shoulder instability and shoulder stabilization procedures were in the top four most commonly performed surgical procedures. In sports like baseball, the shoulder produces the highest angular velocities of any human movement (greater than 7,200 ˚/s) 1 and places tremendous stress on the shoulder complex (Up to 1x body weight), making the it susceptible to various non-contact injuries. The shoulder complex is frequently injured during sports and everyday activities.
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