• The shoulder joint, or glenohumeral joint, is one if the most frequently injured joints in athletes
• I deal with many shoulder injuries in my practice
• Most shoulder injuries can be treated with chiropractic care and the patient can expect recovery
• Some of the most common injuries to the joint are:
  • Instability
  • Rotator Cuff Injury
  • Superior Labrum Lesion

• There is increasing evidence that the pathophysiology of rotator cuff injuries are more complicated than previously thought
• The way the tendon heals has a great impact on treatment and recovery
• Tendons are usually injured in 2 ways:
  • Direct trauma – usually in contact sports
  • Senescence – gradual ‘wear and tear’ though aging and overuse
    • Apoptosis of fibroblasts (laser therapy can stimulate fibroblasts to produce more collagen to speed healing)
    • Decrease in cell activity (laser therapy can stimulate the cells involved in healing to increase activity)
    • Disorganized collagen (resistance training can help reorganize the collagen into strong tissue to deal with mechanical stress).
    • Decrease in ECM synthesis

• Rotator cuff pathology usually increases with age
• Since there are many different etiologies to rotator cuff injury, treatment, rehab, and return to play have to be tailored for each person
• Factors considered are:
  • Age – the older you are, the longer it will take to recover
  • Expected chance of recovery – severity of injury and other factors
  • Dominant extremity involved – dominant extremity is used much more and may take longer to recover
  • Extent of the pathology (i.e. tendonitis vs a tear)
  • Co-existing pathology – involvement of other structures, or conditions (for example, diabetes can impair tissue healing)

RETURN TO PLAY

• There are a couple of GENERAL rules for return to play when dealing with rotator cuff injury
  • Full ROM
  • Full strength
  • Pain-free, or mostly pain-free

• Athletes involved in overhead sports with pain when they return to play generally have set backs or recurrence
• Overhead athletes usually have functional changes in the shoulder to accommodate for the motion that they use when playing a particular sport
  • For example: Athletes engaging in overhead sports such as baseball (throwing), volleyball, and tennis generally have excessive external rotation and decreased internal rotation
  • This phenomenon is known as GIRD – Glenohumeral Internal Rotation Deficiency
    • Common treatment option in this case is to stretch the posterior capsule, which can be done with GH mobilizations
    • Since GIRD is a common occurrence in overhead athletes, it is not necessary to address it before return to play

REFERENCE

Park, H. et al. 2004. Return to play for rotator cuff injuries and superior labrum anterior posterior (SLAP) lesions. Clinics in Sports Medicine , Volume 23(3): Pages 321 – 334