Shoulder instability has a well-recognised risk of recurrence, particularly in young, active individuals involved in contact or overhead sports. While surgery can substantially reduce this risk in appropriately selected patients, neither surgery no rehabilitation completely eliminates it. The decision to return an athlete to training or competition therefore deserves the same level of rigour as the initial diagnosis and treatment.

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Historically, return-to-play decisions have often relied heavily on subjective factors. If an athlete reports no pain, has regained a good range of motion, has limited apprehension and feels confident, they are frequently cleared to return. While these factors remain important, they are not always reliable measurements.

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Feeling ready does not necessarily mean the shoulder is ready to tolerate the demands of high-level sport. There is growing recognition that return-to-play decisions should be based on objective criteria wherever possible.

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Recent work, including contributions from researchers such as Margie Olds, has highlighted the importance of using structured assessments to reduce uncertainty and better identify athletes who may remain at increased risk of recurrent instability.

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Measuring Readiness Beyond Symptoms and Strength

At Axis Sports Medicine, we incorporate a comprehensive return-to-play assessment into our management of shoulder instability (and other injuries). This assessment is designed to complement the excellent rehabilitation undertaken by our patient's physiotherapists rather than replace it.

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A key component of this assessment is objective strength testing. The rotator cuff and scapular stabilisers play a critical role in dynamic glenohumeral stability, and deficits may persist long after symptoms have settled. We use quantitative strength testing to compare the injured shoulder with the uninjured side and assess whether sport-specific strength has been restored. It is important to remember that restored strength does not necessarily mean the shoulder has fully recovered.  Strength is one marker of readiness, but it does not directly reflect biological healing or fully capture an athlete's ability to tolerate the demands of their sport.

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As a result, it is important that strength testing is interpreted alongside other objective measures, rather than being viewed in isolation.

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In addition to strength testing, our return-to-play assessment also incorporates validated patient-reported outcome measures, as assessment of psychological readiness, and confirmation that the athlete has successfully completed progressive sport-specific rehabilitation, including training drills and competition simulations. Together, these measures provide a more complete assessment of readiness than symptoms or strength alone and help identify any remaining deficits before unrestricted return to sport.

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For athletes returning to contact sport, we also consider external support. Shoulder bracing or taping may provide an additional layer of protection during the early phases of return to play, particularly in sports where recurrent instability carries significant consequences. In some cases, this can be fully funded by ACC. While these interventions are not a substitute for rehabilitation, they can form part of a comprehensive risk reduction strategy.

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Supporting a Safer Return to Sport

The final decision is therefore based on multiple domains rather than a single clinical finding.

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Objective strength, functional performance, patient-reported outcomes, sport-specific demands and, where appropriate, the use of protective bracing, all contributes to a more informed decision-making process. This approach is important because the consequences of recurrent instability extend well beyond a missed game.

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Recurrent dislocations increase the risk of progressive bone loss, cartilage injury and more complex further surgery. Getting the return-to-play decision right the first time is therefore an important part of protecting an athlete's long-term shoulder health.

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A player's physiotherapist plays a central role in rehabilitation, and we recognise the expertise required to guide patients through this process. Our role is to provide an additional layer of objective assessment when athletes are approaching return to sport Rather than relying solely on symptoms or confidence, we can help quantify readiness and identify any remaining deficits that may arrange further rehabilitationbefore full clearance.

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If you have a patient with shoulder instability who has completed rehabilitation and appears return to return to sport, whether they have been managed non-surgically, undergone a Bankart repair or a Latarjet procedure, we would be pleased to assist. Our objective return-to-play assessment provides both clinicians and athletes with greater confidence that the shoulder is prepared for the demands of competition.