2022 Bern Consensus Statement on Shoulder Injury Prevention, Rehabilitation, and Return to Sport for Athletes at All Participation Levels

Abstract

Professional and amateur athletes alike are burdened by shoulder injuries. 7,44,48,49,78,88 Shoulder pain affects athlete performance, training, and daily life. 61,64 More than half of elite collegiate American football players sustain at least 1 shoulder injury during their career. 48 Shoulder injuries are a problem for athletes in sports as diverse as rugby, 54 baseball, 34 handball, 20 diving, 73 water polo, 73 and kayaking. 41 Yet, there is a lack of quality evidence to guide clinicians, athletes, and coaches in managing shoulder injury risk or return to sport (RTS) post injury. The absence of quality evidence hinders those who wish to produce clinical practice guidelines. Previous consensus statements have targeted specific shoulder pathologies 4,31,60,89 and the scapula. 50 However, questions remain: • Which exercises are most appropriate for supporting primary prevention of shoulder injury in athletes? • Does screening for muscle weakness, such as a loss of rotational strength in the shoulder, hold value for athletes? • Which load management measures are relevant for the athlete with shoulder injury?U SYNOPSIS: There is an absence of high-quality evidence to support rehabilitation and return-tosport decisions following shoulder injuries in athletes. The Athlete Shoulder Consensus Group was convened to lead a consensus process that aimed to produce best-practice guidance for clinicians, athletes, and coaches for managing shoulder injuries in sport. We developed the consensus via a 2-round Delphi process (involving more than 40 content and methods experts) and an in-person meeting. This consensus statement provides guidance with respect to load and risk management, supporting athlete shoulder rehabilitation, and decision making during the return-to-sport process. This statement is designed to offer clinicians the flexibility to apply principle-based approaches to managing the return-to-sport process within a variety of sporting backgrounds. The principles and consensus of experts working across multiple sports may provide a template for developing additional sport-specific guidance in the future.

Diagnosis, prevention and treatment of common shoulder injuries in sport: grading the evidence – a statement paper commissioned by the Danish Society of Sports Physical Therapy (DSSF)

“…Despite few identified studies of moderate evidence quality, the effect sizes are comparable to other body regions 62. Our findings provide preliminary data to support the implementation of shoulder prevention programmes—in line with the recommendations from a recent consensus statement which concluded that ‘injury prevention programmes/exercises are appropriate to prescribe for athletes of all levels to prevent shoulder injury’ 8. However, three studies of low quality showed no preventative effect of exercise-based interventions, suggesting that investigations into differences in effects of exercise intervention characteristics (ie, frequency, type, dose, volume) is necessary to guide clinical practice.…”

“…However, three studies of low quality showed no preventative effect of exercise-based interventions, suggesting that investigations into differences in effects of exercise intervention characteristics (ie, frequency, type, dose, volume) is necessary to guide clinical practice. Further, we recognise that effective shoulder injury prevention programmes do not always directly elicit improvements in modifiable risk factors60 (eg, glenohumeral internal rotation deficit, muscular imbalances, or scapula dyskinesis),5 6 and that exercise progressions1 44 and exercises individualised to sports-specific movements throughout the whole range of motion may be preferable 1 8…”

“…Athletes from these sports are often referred to as ‘overhead athletes’. It is widely accepted that these athletes are at significant risk of sustaining shoulder injuries, with several attempts made to identify risk factors and optimal management 5–8. The risk of shoulder injuries varies across sports and depends on the definition (time loss in sports, medical attention, severity etc).…”

Risk Factors for, and Prediction of, Shoulder Pain in Young Badminton Players: A Prospective Cohort Study

“…Despite potential strengths, the present study shows certain limitations. Based on the fact that SP is multifactorial, several modifiable risk factors have been proposed in addition to limited rotation ROM, such as asymmetric ROM, rotational strength imbalance, weakness of the external rotators, altered scapular kinematics or load changes depending on the technical gesture [ 63 ]. The ratio between eccentric antagonist and concentric agonist strength is important when analysing shoulder symptoms experienced by badminton players [ 53 ].…”

Risk factors and prevention strategies for shoulder injuries in overhead sports: an updated systematic review

“…Shoulder pain is one of the most common musculoskeletal complaints and can be extremely debilitating [ 47 ] for athletes in overhead sports [ 41 ]. In these sports, the shoulder joint is at high risk for overuse injuries due to their similar load and risk profiles [ 10 , 15 , 27 , 38 ].…”