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Andrew Luck shoulder injury: Managing expectations for his recovery

With an ocean of different opinions on the outlook for Andrew Luck’s recovery from shoulder surgery, Stampede Blue tries to peel through the layers of possibilities so fans will know what they can expect in 2017

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NFL: Indianapolis Colts at Minnesota Vikings Bruce Kluckhohn-USA TODAY Sports

As a football fan, I’m somewhere in the deepest and darkest part of withdrawal as I can be at this time during the year. Waiting months for the return of the Colts to the playing field is excruciating. I hope you understand then, that when the most important piece of the Colts football team is on the mend from surgery, I can’t accept the idea that anything will keep him from taking the field Week 1 of the 2017 season.

How could it? I’ve waited so long. It won’t happen. It can’t happen. I refuse to believe it. So, yes, I will trudge on convinced that Luck will be ready to go for the regular season that is just six weeks away.

Now, if we are going to discuss brutal truth and reality? We don’t know yet. Luck might be ready to take the field and he might require more time. How much more time? Well, that depends on a lot of things that we can’t control.

At this point, I’m sure most everyone is tired of talking about it and hearing about it but I think it’s important that all fans have a chance to fully wrap their heads around what is involved with Luck’s injury and keep it in mind as we learn more about his progress in the coming weeks. To that end, this will be the last thorough story I write about Luck’s shoulder and will try to be as informative as possible with as little conjecture as I can about where Luck is and when we might expect him to be back on the field hurling the pigskin to Colts receivers.

Andrew Luck’s Current Timetable

A tweet from Jim Irsay on January 19th, 2017 informed Colts nation that Andrew Luck underwent successful surgery on his throwing shoulder. He doesn’t say the exact date for the surgery so we will use the date of his tweet as the surgery date for the purposes of trying to figure out where Luck is in the process of recovery.

Possibly the most informative and complete tentative timetable for the progression of patients from recovery to strengthening is provided by PhysioDC.

The recovery time can be separated into three stages. The first is acute pain stage (difficulty when sleeping), which usually lasts 4-6 weeks. This time usually involves a formal physical therapy process.

The second stage is continued strengthening and stretching with slight discomfort (minimal to no pain). During this stage the patient/client will report “I still feel like I am going to dislocate and have this funny crackling in my shoulder”. This stage can range from 12-16 weeks (therapy to post rehab transitional stage). Don’t be alarmed. The labrum repair tightened the joint and likely causing minor pressure on the repaired tissues that are unfamiliar. This feeling will recede over time.

The final stage is the transition to your “new normal” lifestyle and exercise. This stage varies and could be 6-12 weeks of feeling “normal again”. Realistically, many patients are looking at 9 months to 1 year of total recovery time before they feel “normal” again.

This road map gives us some idea of where we might expect Luck to be in his recovery based upon recent reports of his progress. The initial healing phase was over months ago. The rehabilitation stage took somewhere around three to four months after that. This would place Luck in a position to begin the final stage of his recovery after 22 weeks, one week ago.

If we’re one week into a 6-12 week final stage, barring setbacks, Luck could feel normal again and be ready to possibly compete in a football game prior to Week 1 — five weeks from now would put us around September 4th, Week 1 in Los Angeles is September 10th. If he requires an additional six weeks of recovery time he would be ready to return either for the home game against the 49ers in Week 5 or the road game against the Titans in Week 6.

The question that cannot be answered is which area of the spectrum Luck will fall.

If he has been meticulous, the doctors have been meticulous, and the team has been meticulous in making sure he feels beyond prepared for the next step in his return to football, maybe he will be ready to return for Week 1 and will see his progress back to “normal” accelerated.

If he has been has been limited to the longer end of the timetable because his recovery has been on the slower side of the spectrum, he could miss up to five games (maybe six if they choose to put him on inactive PUP to start the season).

The real silver lining for Luck and the Colts though, is that regardless of his actual timetable, a full recovery is the most likely outcome.

A vast majority of patients have full function of the shoulder after labrum repair, and most patients can return to their previous level of sports with no or few restrictions.

At least that gives fans something to look forward to... right?

Worst Case Scenario

Ohio State football fans are likely already familiar with Braxton Miller’s shoulder surgeries. In February of 2014, Miller had surgery to repair a torn labrum in his throwing shoulder. Then, without warning and to the shock of doctors and the team, he re-injured the shoulder six months later while making a normal practice throw.

This is not common and is unlikely to be the experience Andrew Luck will have when he starts throwing the ball again at practice but it can happen.

"Having an injury from throwing a single pass without any contact during a comeback from a labral repair, that would be unusual," said Dr. Orr Limpisvasti, an orthopaedic surgeon and sports medicine specialist at the Kerlin-Jobe Orthopaedic Clinic in California. "That's not typical."

It is important to note that Miller re-injured his shoulder while throwing during practice six months after the initial surgery. The Colts have placed Luck on the active-PUP list to start training camp without a time table for his return to the practice field — and it has been just over six months since his surgery.

Now, as to outlook for recovery from these surgeries? There are numerous opinions but it is in Miller’s story where some of the most negative outlooks come to light.

"I can tell you that the labrum doesn't heal particularly well," Dr. Schickendantz said. "The surgery is difficult, the blood supply is poor and it's hard to get these things to heal. It's a difficult thing to come back from.

"If you look across the board, successful return to play is not all that predictable. People don't understand how difficult it is to come back from that type of surgery. So I am not completely surprised he is having ongoing issues with the shoulder."

While this is true and helps explain the lack of an ascertainable timetable for a return, Dr. Limpisvasti did state that there is a good reason to believe that quarterbacks will have a successful return.

"You wouldn't think twice," Dr. Limpisvasti said. "It's not uncommon for elite quarterbacks to suffer a labral tear. And if there's good tissue to repair and enough time to rehab, they should do well."

Braxton Miller’s story is about is bad as it can get. He went through surgery, rehabbed for six months, re-injured his throwing shoulder on a routine throw, had to have surgery again, had a longer projected timetable for his full recovery from 9 to 12 months, and a decreased likelihood that he would return to top level performance following the second surgery.

The moral of the story here is that rushing back and risking re-injury to the shoulder is the worst thing that Luck or the Colts could do and if they did do so, would create the greatest potential threat to his full recovery and to his timetable for return. Also, full recovery can take up to 12 months. If that happened, Luck would likely miss the entire season.

Should Fans Be Worried?

Where a lot of my conjecture comes into play is that I’m not surprised with where Luck is at this point. Neither is Dr. Jene Bramel, who took the time to speak with Matt Danely on the Stampede Blue Colts Cast.

Generally, labral recoveries, if you look at the rehab protocols, some players can be released to throw as soon as twelve weeks to four months after the injury, some are at the five and sixth month window. We’re getting kind of close to the six month window with Luck. My feeling, just based on the fact that they released Luck to speak to the media at all, is that he probably could be cleared to throw already but there is no sense to bring him back a day early than they feel like they need to... to run the risk that there is a little bit of a setback, that there is any kind of inflammation that would set his throwing program back a couple of weeks to where instead of maybe not having 100% arm strength for week 1, maybe he is not available for a month into the season just based on pushing things a little bit.

So I think that they have a pretty good sense of exactly how many days Luck needs to build up enough arm strength to be ready for week 1. Even if that is not 100%, he has not been playing at 100% for two years so I think that’s where they are and I think Will’s tweet probably lends a little credence to that too but until we see them officially clear him to throw, I don’t know that we can say with certainty that he could be throwing today if they just allowed him to.

Neither is Dr. Brian Shulz, who spoke with the Indy Star in June.

People are probably worried, he had a labrum repair and he’s not throwing five months later, but that is not alarming to me at all. There’s no point for the team to push him with the season still a few months away.

Dr. David Geier also gives the fans a reason to feel confident that Luck will successfully return from the injury and provides an average period of time it takes to return to the field that would put Luck somewhere in the mid-September to early-October time-frame.

90% of the players (54 of the 60) successfully returned to play in a regular season NFL game after shoulder stabilization. Among the players who did return to play, the average time between surgery and the first game played was 8.6 months. None of the 60 athletes returned to play in the same season in which he underwent surgery. Most of the athletes who had surgery in the offseason returned in time to play at the start of the following season.

The lead author of the study, Matthew J. White, MD, summarized his group’s findings. “Our study highlighted the success rate of return to play following shoulder stabilization surgery. Age, number of games before surgery, and career length were not statistically different between those that returned and those that did not.”

Despite all of the reasons to believe that Luck could very well return completely healthy and ready to play to start the regular season, the details provided by medical experts make it very clear that there are no guarantees.

Worst case? Luck suffers a setback that requires another surgery and potentially another year of recovery time. Barring that, his healing processing and recovery could be on the long side of the time-frame provided and he could miss all of 2017.

If he falls within the average or predicted possible recovery range, he could very well take the field for the Colts season opener.

Until he does take the field, though, we just won’t know. Worrying is only natural for fans, so feel free to do so. Also, don’t expect much from Luck or the team until he actually is ready to go. There’s no way they will know specifically when he is ready until that time comes.