It depends on who you listen to.
The recommendation most commonly used has been that most football players who have dislocated their shoulder for the first time can usually return to play within six weeks of the injury if the injury is managed without surgery.
Photo 1: Gold Coast Bulletin / Photo 2: https://www.wikiwand.com
They say it is safe for the athlete to return to sport once full range of shoulder motion and strength has been regained and the athlete is able to perform all of the actions required for their sport.
This is often called a graduated return to sport (GRTS).
Graduated (progressed in stages) RTS is not often gradual (slow, considered).
It is often very fast.
Many professional athletes may be exposing themselves to the risk of long-term disability and pain because of short-term thinking applied when they are injured and aiming to RTS as quickly as possible.
When important structures in the shoulder have been torn they don’t miraculously heal after a first dislocation. Remember that much-loved pair of jeans when they tore at the knee? Did you have to learn to squat differently if you chose to wear them again and didn’t want the tear to worsen? When they were patched lightly did you still squat differently?
There is also the issue of regaining full ROM and strength. Physiotherapists will compare shoulders to determine when the injured shoulder is similar to the other one (expecting minor differences that are common). If everyone is expecting a player to return to sport after 6 weeks do you think there may be some pressure on the physio to help the player achieve this?
A real difficulty when testing sports-specific functional ability for the athlete playing contact sport for both the athlete and the physiotherapist is how to test safely. We can safely test strength because it slowly challenges the shoulder. Often ROM is similarly safe to test. When it comes to sports specific testing in contact sports, full contact carries large risks. Who wants to be the physiotherapist who has supervised the recurrent dislocation of an injured athlete’s shoulder?
We know that timeframes for expecting full recovery from many other injuries have extended as we learn more about them (hamstring muscle is a case in point).
I would suggest that a longer time frame may be significantly safer following first dislocation if managed conservatively (non-surgically).
We know that ruptured (torn right through) structures elsewhere in the body require adaptations to compensate for the change. When a dislocated shoulder is not repaired that change is forever.
After anterior shoulder dislocation (top left image) improvements in strength and control of the muscles both near the shoulder and more generally around the body are essential.
Men are at greater risk of recurrent dislocation than women. Being under 40 makes you much more at risk. That makes a lot of sense when you consider the risks people under 40 take relative to older people (ditto for the risks many men also take). People with increased joint mobility around the whole body are more at risk of recurrent dislocation and we see this all the time at our practice.
The rate of recurrent instability decreases as time from the initial dislocation increases. This seems like I am saying the same thing in different ways but it is also important. Giving the body time to adapt so that everything can protect the vulnerable shoulder while maximising performance is crucial when aiming for a safe RTS. Take a close look at the taped left shoulder and arm in the photo after return following surgery and frozen shoulder for the elite athlete in the photos above.
The limited evidence available supports primary surgery for young adults, usually male, engaged in highly demanding physical activities who have sustained their first acute traumatic shoulder dislocation. There is no evidence available to determine whether non-surgical treatment should not remain the prime treatment option for other categories of patient. More and better trials are required.
Long term surveillance of outcome, looking at shoulder disorders including osteoarthritis is also required. Reviews comparing different surgical interventions and different conservative interventions including rehabilitation are needed.
Those players who undergo surgery usually require five to six months of rehabilitation before they are able to resume contact and collision sports.
How long should return to football take after social distancing?
From first thing Wednesday, May 12, 2020, footballers from the 10 Victorian AFL (men’s) teams will actually be permitted by the government to use their club facilities.
Form and Practice has physiotherapists who really care about the risks associated with return to sport performed too hastily. If you would like advice about a tailored rehabilitation program or testing and advice before returning to sport, consider a review with us.