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Post-Operative Shoulder Management for the Athlete

In the world of sports medicine, it's not uncommon for athletes to face scrutiny when they report persistent pain or injuries. Often, they are labeled as "soft" or accused of lacking the toughness required for their sport. However, a recent case involving a hockey player I assessed and treated highlights the critical importance of a systematic neuro-functional approach.
This elite hockey player had a history of shoulder instability with a bankart repair at the age of 19 and more recently had a humeral avulsion of the glenohumeral ligament (HAGL) repair at the age of 24. 
Now 7 months post op, he was still struggling with persistent anterior shoulder pain. This discomfort was attributed to a lack of resilience and he was called “soft”. During the assessment, it was discovered that the athlete had limited neck rotation and poor left lateral flexion. His supraclavicular nerves and brachial plexus were inflamed and adhered between the scalenes and pec minor. Furthermore, his glenohumeral joint had undergone significant trophic changes from both surgeries and trauma. His commitment to training and intense overhead workouts during the summer had only exacerbated the problem since he did not have the proper ROM required. This further propagated the irritation of the C5-C6 nerve roots that innervate this area. The athlete had tried other conservative treatments as well as PRP (Platelet-Rich Plasma) and cortisone shots, but the results were limited.
After a comprehensive assessment and treating the high value structures that we found of his shoulder and neck region, there was a noticeable improvement in his range of motion, and his pain had significantly subsided. The athlete returned to his team with a modified exercise program that targeted weak and affected musculature.
The athlete also said “I never had a treatment like this or in those areas”.  This saddens me,  someone in pro sports still does not get the assessment and treatment of target regions that is needed to get results.  
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This case serves as a perfect example of the significance of a systematic assessment approach in sports medicine. Other treatments such as PRP or Cortisone can be effective when used at the right time and right conditions. Most importantly, it highlights the need to look beyond the obvious and not blame the patient for being "soft."
The athlete's revelation that no one had ever examined his neck before is a stark reminder of the importance of a systematic neurofunctional assessment. Missing critical regions can lead to unresolved pain and movement disorders. Therefore, it's crucial for healthcare professionals to adopt a comprehensive approach to diagnosis and treatment.
In conclusion, this case underscores the necessity of a holistic assessment in sports medicine. Blaming the athlete should not be the default response. Instead, let us recognize that sometimes, it's our approach that needs adjusting. By doing so, we can provide the best care possible and help athletes achieve their full potential.


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