Rehabilitation and return to sports after anterior shoulder stabilization

Anterior shoulder stabilization has become the treatment of choice for athletes after anterior glenohumeral dislocation. Rehabilitation after surgical stabilization plays a vital role in returning the athlete to their desired sports participation level. Historically, rehabilitation, progression, and return to sport clearance after anterior stabilization surgery has been based on tissue healing and elapsed time from surgery. In general, good to excellent functional results have been achieved with this approach and a large proportion of athletes are able to return to sports, with low recurrence rates. However, substantially fewer are able to return to preinjury levels of sports participation; inadequate assessment and thus management of risk factors may be a potential cause. Rehabilitation guidelines and evidence provide only scant information for the clinician when assessing an athlete’s preparedness to return to sports. Additionally, the unique demands of each sport and non-modifiable factors create an additional layer of complexity in return to sport decision making. In this review article, rehabilitation guidelines after anterior shoulder stabilization, examination of factors utilized to determine return to sports preparedness, and clinical tests and measures that may be used during decision making are discussed. The importance of matching rehabilitation interventions based on the goals of each stage and criterion based progressions are emphasized. Establishment of the fundamental motion, strength, and stabilization is paramount before entering into return to sport preparation and testing. Once the athlete is nearing return to sport, appropriate tests and measures must should be performed to replicate the demands commonly placed on the shoulder during sports. Based on the available evidence and the unique functional requirements of each sport, it is recommended that a battery of tests and measures are utilized to assess multiple aspects of sports participation.