Accelerated Return To Elite Rugby League Following Labral Repair

Contact sports like Rugby League are often rough on the joints and soft tissue structures of the body. Frequent impacts and heavy tackle collisions can cause structural damage to the shoulder and acute injury needing medical attention.

In 2007, a study of 142 rugby players indicated that tearing of the glenoid labrum occurred in as many as 35% of rugby players. The glenoid labrum of the shoulder is integral in maintaining shoulder stability and a structural tear can cause instability, pain and even dislocation.

Tears of the labrum are divided into two categories, SLAP and non-SLAP tears. SLAP stands for Superior Labrum Anterior to Posterior and refers to the position and direction of the tear. A serious tear to the shoulder labrum will render a player unable to compete and may require surgical intervention. The post operative rehabilitation to prepare the athlete to return to play often being extensive.

rugbyleague A clinical case study was recently completed involving a 29 year old professional rugby league player who underwent a labrum repair. His recovery and rehabilitation were monitored and documented in order to evaluate the treatment and improve the outcome of future players.

Post-surgery the patient’s affected arm was completely immobilised for 3 days, with mobilisation beginning at day 3 as tolerated. The patient was given education and training in correct posture and physiotherapists treated pectoralis major and the posterior shoulder capsule to reduce tightness and improve posture.

The rehabilitation program centred on strengthening the shoulder and arm. This was achieved via a progressive program that incorporated isokinetic elastic, weight bearing and resistance exercise.

Isometric exercise was undertaken in order to promote dynamic stabilisation, proprioception and neuromuscular control, in addition to increasing muscular coordination, control, and endurance. Isokinetic exercise refers to movement through a range against a constant resistance. This kind of exercise is effective postoperatively as it minimises the potential for injury and is less likely to create muscle imbalances than traditional resistance exercise.

Exercises were rapidly progressed using elastic bands. Within the first week Internal rotation, external rotation and low rowing movements were performed as tolerated to strengthen the rotator cuff. As strength progressed internal and external rotation exercises were completed with the arm in 90 degrees of abduction. This position strengthens the shoulder within a range that with will maximise shoulder stability once the player has returned to rugby. Closed chain exercises such as push ups were also introduced early in the program in an attempt to mimic the actions involved in rugby, such as getting up off the ground.

Weight training was introduced gradually from week 2, with cable weight resistance being performed first. The patient was able to exert 25nm of torque at this stage, compared to an uninjured average of 70nm. In order for strength to reach normal levels, the resistance load was increased as tolerated. Pulling exercises were introduced at week 4, and pushing exercises at week 5. Weighted pushing exercises were introduced last as they place a greater load on the posterior labrum and have the potential to cause injury if introduced early. The orthopaedic surgeon who operated on the patient consulted closely with physiotherapists throughout the introduction of weight training in order to avoid reinjuring the shoulder.

Clearance to begin full contact training was dependant on the isokinetic score of the injured shoulder being within 10% of that of the uninjured shoulder. The ability to lift free weights at a pre-injury level was also a criterion, as was rotator cuff strength and adequate shoulder proprioception. The clearance to play was given at 15 weeks post operatively.

This study is a good indication of the process involved in returning an athlete to the playing field following shoulder surgery in an efficient and safe manner.

Funk, L., & McDonough, A. (2013). Critical reflection of the advanced rehabilitation of an elite rugby league player. Physical Therapy in Sport, 60-67.

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