2022 Bern Consensus Statement on Shoulder Injury Prevention, Rehabilitation, and Return to Sport for Athletes at All Participation Levels | Journal of Orthopaedic & Sports Physical Therapy

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“ Injury prevention programs/exercises are appropriate to prescribe for athletes of all levels to prevent shoulder injury.”

“Fundamental components of exercise programs to manage shoulder injury risk in overhead and contact/collision sports are outlined in Table 1. The principles can be extrapolated to other cases, with the caveat that “recipe-style” approaches should be avoided. Each case should be taken on its own merit, and recommendations should be adapted to suit the individual and the sporting context within which RTS is being attempted.”

“The balance between capacity and load plays an important role in injury risk management, rehabilitation, RTS, and performance enhancement.”

“Key Principle: Let Irritability Guide Rehabilitation Progression Progress through rehabilitation is governed by the level of irritability and is unique to the patient; it has little to do with specific pathology. High irritability is considered as high pain at rest, night pain, or high disability. Low irritability includes low pain levels, pain that is limited to specific activities or movements, and no night pain. A staged approach has been described for shoulder disorders, with a rehabilitation classification based on irritability.”

“Key Principle: Do Address the Scapula in Rehabilitation but Do Not Screen for Dyskinesis Screening for scapular dyskinesis in athletes without shoulder symptoms may provide little to no value. Dyskinesis is present in 53% of healthy people and 61% of overhead athletes. In overhead athletes, sport may contribute to muscle imbalance and asymptomatic scapular dyskinesis.

Consider the scapula as part of a holistic approach to rehabilitating the shoulder complex, for example, strengthening the kinetic chain to improve scapular mechanics.”

“Key Principle; Train the Brain Injury provokes changes in the cortical area of the brain that outlast the injury itself. During rehabilitation, there is an opportunity to capitalize on the brain’s plasticity to reverse the brain changes that occur after injury.

Gradual exposure to fearful movements that provoke anxiety for the athlete, and use of motor imagery and mirror neurons with mimicking and adapted cognitive-compartmental therapies, can be incorporated

Key Principle: Sport-Specific Exercises Incorporate single-plane exercises at any point to achieve a specific goal (eg, addressing specific strength, power, or endurance deficits). However, clinicians must ensure that athletes progress to complex, multiplane exercises and ultimately sport-specific movements (with good quality) as soon as it is appropriate. Consider power (including rate of force development) for exercise selection from a joint-protection and performance perspective in preparation for sport.”

RTS Decisions

“Return to sport occurs along a continuum: from return to participation, to RTS, to return to performance.”

“The following definitions provide helpful context:

Return to participation: the athlete participating in rehabilitation, training (modified or unrestricted), or sport, but at a level lower than his or her RTS goal. The athlete is physically active, but not yet “ready” (medically, physically, and/or psychologically) to RTS. It is possible to train, but this does not automatically mean RTS.
Return to sport: the athlete returning to his or her sport, but participating below his or her previous or “desired” level of performance.
Return to performance: the athlete playing a full game without restrictions or throwing the number of pitches in a game at the same velocity as he or she did before injury.”

“The ER/IR strength ratios are important for athletes in overhead/throwing sports, but should not be used in isolation. Absolute strength values also need to be considered to determine functional shoulder capacity.”



2022 Bern Consensus Statement on Shoulder Injury Prevention, Rehabilitation, and Return to Sport for Athletes at All Participation Levels | Journal of Orthopaedic & Sports Physical Therapy

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