Time lost due to injuries and operations has a great impact on sportsmen and the absence from their teams may impact on their position in their teams and their income. One should tailor the treatment and permission to return (given by the surgeon and rehab team) optimal consideration.
It has been my observation that often blanket rules are applied without knowledge or attention to the exact patho-anatomy of the specific injury or operation

For each different injury and operation different rules would apply. In a short series of these blogs we will examine the different injuries, their management and when players could be allowed to return to their previous activity levels. In most injuries the following has to be taken into account:

1. Have the damaged structures healed to be able to sustain the demands of the particular sport?

2. Has the flexibility, co-ordination and muscle strength returned to the previous level?

Once these criteria are satisfied the player can usually be returned to his full sporting activity.

In the following few blogs the different injuries will be examined and the surgical procedures used in some of them will be mentioned with guidelines as far as return to play are concerned.

Of particular interest to me has been the concept of “accelerated rehab” for professional rugby players and that will be addressed in this series


About Joe de Beer

I am an orthopedic shoulder specialist. I am passionate to share tools and information with people to empower them to manage their shoulder problems successfully with the least intervention
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  1. Rozanne Schreiber says:

    Dr De Beer. as we look at the return to play after any injury we as physiotherapist also need to adress not just muscle strenght but muscle endurance. Stabilizers (local and global) function in an endurance component and are of utmost importance for stability. We also need to focus that stabilizers must be active in all ranges of motions and that include the scapula stabilizers and the rotator cuff. like you said that co-ordination is important but propoiception and correct sequence of muscle activation and control are also critical. If we look at control we look at endurance rather than strenght and thats the role of stabilizers

    • Joe de Beer says:

      Dear Rozanne,
      I agree with you and that the strength, endurance , balance and proprioreception of the stabilisers and movers around the shoulder are extremely important concerning the return to play. What I would like to point out in the next few blogs are the different aspects for each different injury and operation. There is an important aspect to consider the healing of the repaired structures ( taking into account not only the specific structure repaired but also the surgical technique used) and then the difference for the specific sports ( bowling in cricket has a different demand to the requirement of a shoulder in rugby for example). Thank for your contribution and I hope you will do so again in the future

  2. Joe de Beer says:


    AC subluxations are common in contact sports and probably the most common shoulder injury in the game of rugby. They are also frequently seen in cycling. The injury can vary from a simple sprain (grade 1) to grade 3, 4, or 5, with grade 3 being by far the most common. In these latter injuries the acromioclaovicular and coraco-acromial ligaments are torn. Presently the most accepted management of these injuries is conservative, with initial management by the physiotherapist using ice ultrasound and other pain relieving modalities. What is important to realise is that with an AC joint subluxation there is minimal, if any, damage to the rotator cuff, labrum or any other intra-articular structures. It is therefore, mostly a question of managing the local pain at the AC joint and rehabilitation may be quick within pain limits.
    It must also be realised that the torn ligaments (coracoclavicular and acromioclavicular) heal within a short period of time (mostly within 3 to 4 weeks and as long as these ligaments are not heavily loaded, activities can be allowed soon. Detrimental loading of the healing ligaments would not occur from everyday activities but only with forced inferior traction on the upper limb or a fall on the tip of the shoulder. The management of AC injuries could be with “expert neglect” – as soon as a player has little pain and function (due to the lack of pain) is increasing, supervised return to activities may be allowed. It has been mentioned to me that some players are only allowed to play again after three months or more – that is entirely unnecessary and in the case of a rugby player, lack of tenderness over the area the AC joint can be regarded as a sign for safe return.

    In the next delivery I will deal with return to play after surgical management of these AC joint injuries.

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