Return to sports after shoulder injury: progressive performance training

Ann Cools, Clinical Pearls / Wednesday, September 11th, 2019

During the RTP phase of rehabilitation, the practitioner must balance 2 conflicting components, on one hand the knowledge that premature RTP increases the risk for re-injury and on the other hand that the player as well as the team desire return to participation as quickly as possible. Combining evidence with clinical expertise, the clinician plans the RTP accordingly. Quantifying and monitoring the progressive training load is key in guiding this process.

Recently, the “control-chaos-continuum” was introduced for lower limb injuries, offering a framework moving from high control to high chaos during sportspecific rehabilitation. The continuum was described for lower limb injuries, but can easily be transferred to upper extremity injuries. The authors suggest to start with “high control” exercises, controlling ROM, speed, training volume, circumstances, with low unexpected environmental forces. During the “moderate control” phase, we can introduce changes of directions, but under controlled circumstances, for instance target throwing or smashing from a still starting position.

In the “moderate chaos” phase, unpredicted movements are introduced with minimal limitations, with the additions of pass and move and specific patterns of play drill. Finally, in the “high chaos” phase, the player returns to weekly training demands and includes drills designed to test “worst-case scenarios” (high speed, unexpected circumstances, one-on-one drills…).

Taberner M, Allen T, Cohen DD. Progressing rehabilitation after injury: consider the ‘control-chaos continuum’. Br J Sports Med. 2019 Feb 8.

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