Have probems with both shoulders. But in terms of the right shoulder, MRI confirmed partially torn labrum and bankart tear. Stability for right shoulder is fine, but endurance is an issue. If I go past 6-8 reps for any exercise, I feel a dull ache and burning in the posterior. I’ve worked with a PT that designed an RPE based program, and was able to gradually build strength in the area (110lbs barbell overhead press for sets of three, 185lbs bench for sets if three, etc) which also minimized pain almost entirely, but I always feel like it’s one good jerk or dynamic movement away from getting worse. My goal is to get back into boxing and MMA, but the shoulder does not do well with dynamic movements and gets tired and fatigued hitting the heavy bag. Is it possible to return to martial arts at a HIGH level with a torn labrum? He claims that it is more than possible but I highly doubt this. Why do pro athletes always get surgery on torn labrums? His response was " Because they don’t have time on their side. You could get back to it but it will just take longer through graded exposure training." He says you can train through injuries to return to pretty much any sport. What’s the truth here?
(Also. I got a PRP injection on the left shoulder for suspected rotator cuff issues and the doc wanta total inactivity for 6 weeks. Is 6 weeks of absolite rest the way to go? Or is this too conservative?)
This is far too individual of a situation for us to be able to provide you a confident opinion the forum; I think your best bet is a consultation with one of our rehab professionals.
To your second question, there is essentially no situation where we advise 6 weeks of absolute inactivity.
Is it possible to engage in combat sports at a HIGH level with a torn labrum? Ive never seen a combat athlete NOT get surgery to repair it. I think it’s impossible but I would like to be proven wrong. I just can’t see how the constant contractions on the ground (BJJ) or constant throwing of punches standing up wouldn’t make it far worse and become essentially useless.
There is A LOT to this question. First, it is absolutely possible to participate in high level martial arts with a labral tear. Some of this comes down to how a program is designed and what it is inclusive of. While getting stronger can certainly be helpful, it is not a panacea to fixing issues. Programs need structured to the demands of the sport and to your point, MMA has a lot of dynamic/faster movements. Those types of movements need scaled as well to build tolerance to both positions, and speed of movements. Think of it like this, if someone had a hamstring strain, we could get their hamstring as strong as possible, but if they haven’t been exposed to sprinting at different levels before returning to sport, it’s not the strength that is going to protect them. The same is true for striking or rolling and getting a shoulder stronger.
As far as combat athletes not getting surgery, unfortunately that is more a product of the system than true efficacy of the procedures. We don’t have the data for MMA but there are countless studies in baseball players and volleyball players showing a high incidence of labral changes in asymptomatic athletes and some studies showing no correlation with having those and it changing career trajectories. I don’t know what level of evidence it would take to prove you wrong but I would happily take a wager that if they repeated the studies above for a weight class in the UFC, you would see the exact same results of asymptomatic changes. To your logic regarding constant throwing of punches, that is pretty similar to the baseball players mentioned above going out and throwing fastballs. It is not so much about the absolute forces as the frequency and intensity. There are plenty of ways from a rehab or S&C perspective to prepare an athlete to produce (and absorb) those forces but they need to be scaled and at a certain point for every athlete, volume and intensity are going to win.
The study below didn’t follow up on the athlete’s trajectory, but looking at the rate of shoulder changes in athletes at the 2016 Olympics, of those imaged 55% had a tear on their labrum. I would be willing to wager that many of them managed to compete at the highest level with those findings and odds are many of those changes had been present long before they developed symptoms.
Thank you both for your answers… does this also apply to grappling? I can’t see how the arm being put in weird and awakeard positions wouldn’t cause more damage and instability to someone doing BJJ ot wrestling… is it even possible to rehab for that?
It is definitely possible. It comes down to being able to structure a program to scale positions. I don’t know that I would slant there are awkward positions so much as novel positions and there are definitely ways of structuring exercises and programs to scale to those needs. Part of this is also related to how programming is structured on the mats as well and finding rolling partners who can help you get in and expose to those positions versus just taking you straight there.