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Return to Play After a Shoulder Labral Tear: What You Need to Know.

  • Writer: PHYSIO 360
    PHYSIO 360
  • Jun 8
  • 3 min read

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INTRODUCTION;

Returning to sport after a shoulder labral tear can be both exciting and anxiety-inducing. Whether you're a contact athlete, overhead thrower, or weekend warrior, the decision to go back to play must be guided by a structured, evidence-based return to play (RTP) test protocol. Here’s everything you need to know about safely getting back in the game.


Understanding a Shoulder Labral Tear

The labrum is a ring of cartilage that surrounds the socket of the shoulder joint, helping to stabilise the ball-and-socket articulation. A labral tear—especially a SLAP (Superior Labrum from Anterior to Posterior) or Bankart lesion—can result from trauma, repetitive motion, or dislocation.

Common symptoms include:

  • Deep shoulder pain

  • Clicking or catching

  • Loss of strength or stability

  • Reduced throwing velocity (in athletes)


Why Return to Play Testing Matters

A labral tear, even after surgery or rehab, doesn't heal overnight. While pain may resolve quickly, functional deficits can linger. Return to play testing ensures that:

  • The shoulder has regained strength, mobility, and stability

  • The athlete can handle sport-specific loads

  • The risk of reinjury is minimised



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Key Components of a Shoulder RTP Test

RTP protocols vary depending on the sport and level of play, but a comprehensive shoulder RTP test typically assesses:

1. Range of Motion (ROM)

  • Goal: Symmetrical ROM compared to the uninjured side

  • Tests: Shoulder flexion, abduction, external and internal rotation

  • Note: Overhead athletes may have normal side-to-side differences (e.g., GIRD), so context matters


2. Strength Testing

  • Goal: At least 90% strength compared to the contralateral side

  • Tools: Hand-held dynamometry or isokinetic testing

  • Focus Areas: External rotation (ER), internal rotation (IR), and scapular stabilisers


3. Functional Tests

  • Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST): Measures shoulder stability and control in a plank position.

  • Y-Balance Test – Upper Quarter: Assesses dynamic shoulder stability and proprioception.

  • Single-arm wall push-up or press-up test: To evaluate load-bearing ability in the injured shoulder.


4. Sport-Specific Drills

  • Throwing Progression (for baseball, tennis, volleyball players): Gradual return to full-intensity throws with attention to mechanics and fatigue.

  • Contact Readiness (for football, rugby, etc.) : Tackle or collision drills at submaximal intensity before full contact is cleared.


5. Psychological Readiness

  • Tools: Shoulder Instability-Return to Sport Index (SIRSI)

  • Why it matters: Fear of reinjury or lack of confidence can affect performance and recovery.


Return to Play Criteria

While criteria vary, here are general RTP guidelines post-labral injury or surgery:

Criteria

Goal

Pain-Free ROM

Full, symmetrical ROM

Strength

≥90% of the opposite side

Stability

Negative apprehension tests

Functional Testing

≥90% on functional scores

Sport-Specific Drills

Completed without symptoms

Psychological Readiness

High confidence score on SIRSI or equivalent

Common Pitfalls in RTP

  • Rushing the process: Returning too soon increases reinjury risk.

  • Neglecting scapular control: Poor mechanics can overload the labrum.

  • Inadequate neuromuscular training leads to instability, especially in overhead athletes.

  • Ignoring mental readiness: Athletes might be physically ready, but mentally hesitant.



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Final Thoughts

The road to recovery after a labral tear is more than just healing tissue—it's about restoring full, functional, and confident use of your shoulder. A structured RTP protocol not only enhances performance but also safeguards your long-term joint health.


If you’re an athlete or clinician navigating a return from a shoulder labral tear, tailor the testing to the demands of the sport and the individual. Remember: Return to play is not a date—it's a performance benchmark.

Need help creating a customised return-to-play plan for your sport? Reach out to a physical therapist or sports physician with experience in shoulder rehabilitation.


REFERENCE AND RESEARCH ARTICLE ;

1.Return to Play After Type II Superior Labral Anterior-Posterior Lesion Repairs in Athletes: A Systematic Reviewhttps://pmc.ncbi.nlm.nih.gov/articles/PMC3348316/.


2.Return to play following nonsurgical management of superior labrum anterior-posterior tears: a systematic reviewhttps://pubmed.ncbi.nlm.nih.gov/35063641/




 
 
 
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