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Shoulder Injury Prevention, Rehabilitation, and Return to Sport for Athletes

Shoulder Injury Prevention, Rehabilitation, and Return to Sport for Athletes

Shoulder injuries are a significant problem in both professional and amateur sports, affecting performance, training, and daily life. Despite their prevalence in sports such as rugby, baseball, handball, and water polo, there is a lack of high-quality evidence to guide clinicians on injury prevention and RTS protocols.

The Athlete Shoulder Consensus Group used a two-round Delphi process and an in-person expert meeting to develop a set of principle-based recommendations. The framework focuses on four key areas:

  • Managing injury risk
  • Managing and progressing load
  • Rehabilitation
  • Return to sport
Key Points of the Consensus Statement
1. Prevention of Shoulder Injuries
  • Injury prevention programs should be integrated into regular training, particularly for youth athletes to establish lifelong healthy shoulder function.
  • Prevention programs should include sport-specific exercises, focusing on:
    • Rotator cuff strength (especially external rotation)
    • Scapular control
    • Shoulder endurance
    • Plyometric exercises for load absorption
  • Screening for risk factors such as muscle imbalances, poor shoulder rotation strength, and previous injuries may be helpful, but there is no strong evidence that it accurately predicts future injuries.
  • Prevention exercises should be performed at least twice a week and incorporated into warm-ups.
2. Managing and Progressing Shoulder Load
  • Load management is crucial, particularly in overhead and contact sports.
  • Sudden increases in training intensity or volume (greater than 60% increase in load over four weeks) are linked to higher injury rates.
  • Monitoring external loads (e.g., number of throws, tackles) and internal loads (e.g., rate of perceived exertion) is recommended.
  • Athletes should be encouraged to self-monitor shoulder exertion levels using rating scales.
  • Load management should be individualized based on shoulder strength and endurance levels.

We will discuss the other 2 key points in the next post. Stay Tuned.

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