After the Eagles announced Carson Wentz would undergo surgery to reconstruct a torn ACL, everyone is wondering when he can play again. This is the first question athletes ask me after ACL surgery and my answer is always, “when you’re ready.”
Athletes want a definitive time frame but that’s nearly impossible to give. Return to play is extremely individual and needs to be based on achieving objective, measurable goals and not an arbitrary time frame.
In the past, sports medicine professionals would give an estimated time frame, often six months, for return to play. But research and clinical experience has shown that athletes rarely fit into arbitrary time frames. Returning too soon following ACL reconstruction can put an athlete at high risk for re-injury or injuring the opposite knee. A 2016 study published in the British Journal of Sports showed that athletes returning to play prior to nine months had as high as a 40 percent re-injury rate. More importantly, athletes who passed an objective-based return to play testing battery reduced their re-injury risk to only 6 percent.
So, what is an objective-based return to play testing battery? There is still debate on which tests are most effective at teasing out any deficits or limitations that would predispose an athlete to re-injury, but most research supports assessing balance, strength, and the athlete’s ability to hop. I I developed a return to practice battery that I have been using for over five years and my unpublished data shows a significant reduction in re-injury rates for the athletes who have passed all aspects of testing. The battery assesses balance, strength, power, hopping, and landing mechanics using simple clinic-based tests and incorporating newer technology such as force plates and 2-D video analysis. This test also helps the athlete return to their pre-injury level of performance.
The last part of the process is the progressive return-to-practice programming. Athletes need to slowly progress activity from simple, straight drills to higher-level cutting and pivoting. They need to progress from non-contact to contact practice. There is also a newer term in sports medicine called acute/chronic work load. This simply means not increasing training load too quickly and not returning a player until they have reached their pre-injury training loads. Professional sports have high-tech ways of measuring this such as GPS tracking and heart rate monitoring where we use more lo tech monitoring for athletes who don’t have access to GPS monitoring
Returning to play following ACL reconstruction is a measurable process based on testing and training data. The Eagles will base Wentz’s return on these objective criteria. Eagles fans can be confident that Wentz will be back on the field, at or near his pre-injury performance level, for pre-season next August.
On Sunday, the 76ers released an update on guard Markelle Fultz’s right shoulder injury. They stated that after a visit with Dr. Ben Kibler in Lexington, KY, it was confirmed that Fultz did not have any structural impairment but he would be out indefinitely with soreness and scapular muscle imbalance.
Scapular muscle imbalance, also known as scapular dyskinesis, is an asymmetry of the shoulder blades characterized by an abnormal movement pattern of the overused side. This is often seen in baseball pitchers and tennis players due to the repetitive overuse of the throwing or hitting arm. Although typically in basketball, shoulder injuries occur when the arm is blocked during a shot or hits the rim after a dunk.
Media reports stated that Fultz had a cortisone injection earlier in October. These are typically used to reduce inflammation and pain but with Fultz’s continued symptoms, we can assume that the injection didn’t have significant benefit. This supports the scapular dyskinesis diagnosis as injections generally don’t offer relief for this problem.
Return to play can be very difficult to predict, especially with the diagnosis of scapular dyskinesis. Some athletes respond to rehab in a few weeks whereas others require months of work. Rehab focuses on improving scapular stability and movement patters, but also addressing any kinetic chain dysfunctions that may be contributing to the shoulder issue. Sometimes another injury, such as Fultz’s previous ankle sprain, can cause certain muscle groups to overcompensate, resulting in dysfunction elsewhere in the body, like Fultz’s shoulder injury. Think of it as your car’s alignment being off.
The good news in all of this is that the injury appears to be non-surgical. The Sixers will be on top of Fultz’s rehab and will have him back on the court once the scapular dyskinesis and any other movement dysfunctions are addressed. Correcting these dysfunctions will allow Fultz to return to his previous level of performance while minimizing his risk of re-injury.