Cleared for takeoff.
That’s what we hope to hear about Braxton Miller’s current status. After two surgeries on his right shoulder for torn cartilage, we patiently await an announcement this week that will ideally be the green light.
It's been almost a year since his most recent operation last August, and Miller has been hard at work to come back on the field like he never left. So, what has he been busy doing during his time away? Let's review what has happened over the past 10-and-a half months.
The rehab program after a labral repair is split up into three phases:
1. Maximum protection phase. This starts immediately after surgery and lasts about six weeks. The patient is in a sling to limit movement of the shoulder. The point of this is to keep swelling at bay. Less swelling means less pain. Some range of motion exercises are incorporated towards the end of this phase.
2. Moderate protection phase. This spans weeks 6-12. The goal is to regain full range of motion. Another goal is to start some active loading of the biceps. Baby steps. You can already appreciate how slowly this whole process moves. The surgical site is very delicate, and overloading the structures of the shoulder too soon can throw you right back to square one.
3. Minimum protection phase. This starts at week 13 and goes through week 26, which ends up being about six months out from surgery. Miller's six-month mark was at the end of February. Athletes gradually return to easy throwing during this phase. Full strength of the shoulder muscles should be achieved before full activity is resumed. Throwing mechanics are assessed throughout this phase.
It's important to keep in mind that Braxton Miller's "baseline" is very different from that of the typical patient. It would be expected that he take longer to progress through phase three.
Imagine two containers full of water: one is a cup, and one is a gallon. Now, dump the water out and refill the containers with a slow-dripping faucet. Tedious, right? They both take a while to fill back up, but the gallon takes much longer.
For this scenario, the cup is a typical, non-athlete patient. When that patient has a shoulder surgery and starts from scratch (empty cup), it takes plenty of patience, but relatively less time to return to pre-operative functioning and the ability to complete daily tasks without restriction (fill back up).
The gallon is a patient who is an athlete. It takes quite a bit longer for him to return to his previous level when he has to start from scratch with an immobilized shoulder, because his shoulder needs to perform much more complex, rigorous tasks.
Braxton Miller is a bathtub in this analogy. His shoulder functions on an entirely different level than the rest of mankind, and as such, he has to very carefully and appropriately rehab it back to that level. Perfection takes time, and almost 10-and-a-half months takes a whole lot of patience.
A recent systematic review (a study that studies a bunch of other studies) found that 83 percent of athletes who have a surgery like Miller's (labral repair) report good-to-excellent results afterwards. That's a favorable outcome for an orthopaedic intervention. For a reference point, that's about the same success rate reported for Tommy John surgery, which is considered a very successful procedure.
The same study reported 63 percent of overhead throwing athletes (like quarterbacks) return to their previous level of play after the surgery.
There are a few considerations here; good news and bad news.
The good news is that having just under two-thirds of these athletes going back on the field at their pre-operative level of play is an impressive outcome for how much work the shoulder is asked to do for overhead throwing athletes.
The bad news is that this was Miller's second operation on the same shoulder. The data here does not account for that.
Regardless, if Miller announces he has been cleared by Dr. James Andrews, the veteran leader in the field of orthopaedic surgery, it would be all good news for Buckeye Nation. Miller wouldn't be cleared if there wasn't complete confidence in the integrity of his shoulder and his ability to safely return to competition. With fingers crossed in anticipation, we can't wait to see No. 5 suit up for the scarlet and gray.
- Brockmeier, Stephen F., et al. "Outcomes after arthroscopic repair of type-II SLAP lesions." The Journal of Bone & Joint Surgery 91.7 (2009): 1595-1603.
- Sayde, William M., et al. "Return to play after Type II superior labral anterior-posterior lesion repairs in athletes: a systematic review." Clinical Orthopaedics and Related Research® 470.6 (2012): 1595-1600.
- Vitale, Mark A., and Christopher S. Ahmad. "The Outcome of Elbow Ulnar Collateral Ligament Reconstruction in Overhead Athletes A Systematic Review." The American Journal of Sports Medicine 36.6 (2008): 1193-1205.