Returning to Competitive Powerlifting After Bankart Repair: A Case Study
Patient profile
Age: 26 years
Gender: Male
Occupation: Competitive Powerlifter
CHIEF COMPLAINTS:
Persistent left shoulder pain, weakness, restricted movement, and inability to return to bench press performance following recurrent shoulder injury and post-surgical rehabilitation. (Left shoulder labral repair and stabilisation through arthroscopy)
HISTORY:
A 26-year-old male competitive powerlifter with 5 years of lifting experience presented with persistent left shoulder pain, weakness, restricted movement, and an inability to return to his previous bench press performance. The patient sustained an initial left shoulder subluxation following a road traffic accident, after which he underwent rehabilitation but continued to experience reduced force production in the affected shoulder.
Despite these limitations, he achieved his peak competitive performance in mid-2023, totalling 490 kg at a bodyweight of 59 kg:
- Squat: 175 kg
- Bench Press: 107.5 kg
- Deadlift: 207.5 kg
On 27 January 2024, while performing a moderate-load bench press, he experienced an acute shoulder injury with immediate pain and loss of pressing capacity, being unable to bench press even an empty bar afterwards. The patient felt that contributing factors may have included residual weakness from the previous injury, poor warm-up response, and low gym temperature.
He initially pursued conservative management through online and in-person rehabilitation. Although some movements were temporarily pain-free, symptoms repeatedly returned during pressing actions.
An MRI later revealed a labral tear extending from the 3 o’clock to 7 o’clock position, consistent with a significant anterior-inferior labral injury. Multiple orthopaedic consultations were obtained, and several non-surgical treatment approaches were attempted. However, considering the functional demands of competitive powerlifting, surgical intervention was ultimately chosen.
The patient underwent successful left shoulder surgery on 17 April 2024. Approximately six months later, he resumed rehabilitation in our clinic. At the start of rehabilitation, shoulder movement was significantly restricted with pain and functional limitations. The patient remains motivated to recover fully and return to competitive powerlifting.
OBJECTIVE:
To return to competitive powerlifting at his previous level of performance.
LIFESTYLE AND PSYCHOSOCIAL ANALYSIS:
Physical Activity Status:
The patient was previously highly active and involved in competitive powerlifting training with regular structured sessions focused on squat, bench press, and deadlift performance.
Sleep Level:
6-7 hours
Stress Level:
No significant stress reported
Psychosocial Factors
Cognitive Factors
The patient frequently questioned whether he would be able to return to competitive powerlifting and regain his previous performance levels.
Affective Factors
No significant emotional distress was reported.
Social Factors
No major social limitations were identified.
PAIN ANALYSIS:
Intensity: 7/10 while lifting
Aggravating factors: overhead movements, pressing activities.
Relieving factor: Rest
Location: Anterior aspect of the left shoulder
Lifestyle impact:
The patient experienced difficulty with:
- Reaching activities
- Overhead tasks
- Gym training
- Functional upper-limb movements
Fear of movement: Present during overhead movements due to concerns about reinjury.
Understanding the Patient's Problem Based on History and Pain Analysis
The patient’s primary limitations appeared to be post-operative stiffness, restricted shoulder mobility, reduced force production, and decreased confidence during upper-limb loading rather than recurrent instability. These limitations prevented him from performing overhead activities, reaching movements, and powerlifting exercises effectively, which significantly affected both his daily function and athletic performance.
However, history and pain analysis alone are insufficient to identify the exact factors contributing to his ongoing symptoms. Therefore, a detailed physical examination is essential to assess shoulder mobility, strength, stability, movement quality, and functional capacity, and to determine the key impairments limiting his return to competitive powerlifting.
PHYSICAL EXAMINATION:
Observational findings:
Visual assessment revealed noticeable muscle atrophy within the left pectoral and deltoid regions compared to the contralateral side.
Mobility Testing:
The following movement limitations were identified:
- Shoulder overhead flexion mobility: Severely restricted
- Thoracic rotation mobility: Severely restricted
Shoulder Range of Motion Assessment
| Movement | Right | Left |
|---|---|---|
| Flexion | 180° | 150° |
| Abduction | 180° | 150° |
| External Rotation | 90° | 60° |
| Internal Rotation | 90° | 60° |
Strength testing:
Strength was evaluated using an isometric break test.
Significant weakness was observed in:
- Horizontal pressing patterns
- Shoulder external rotation
- Overhead movements
No initial Limb Symmetry Index (LSI) measurements were recorded during the first assessment.
INVESTIGATION:
MRI was taken in January 2025
DIAGNOSIS:
Left shoulder Post-operative stiffness following a Bankart Lesion Repair
The diagnosis was not based solely on MRI findings.
The diagnosis was supported by the combination of:
- History of traumatic shoulder subluxation.
- Recurrent symptoms during bench pressing.
- Persistent loss of force production.
- Significant restrictions in shoulder mobility.
- Visible muscle atrophy.
- Reduced strength on clinical examination.
- MRI-confirmed anterior-inferior labral injury.
- Previous surgical stabilisation procedure.
Importantly, the patient’s primary presentation at the time of rehabilitation was not recurrent instability. Instead, the dominant impairments were:
- Post-operative stiffness.
- Restricted shoulder mobility.
- Strength deficits.
- Reduced load tolerance.
- Fear of reinjury during overhead and pressing activities.
TREATMENT PLANNING:
Expected Recovery Time
Approximately 3–5 months of structured rehabilitation following the initial assessment.
Planned Rehabilitation Duration
- 20–24 weeks
- Approximately 30–36 supervised sessions
Primary Goal
Return to competitive powerlifting
Rehabilitation Strategy
The rehabilitation program was structured around four key principles:
- Restoring shoulder and thoracic spine mobility.
- Rebuilding strength and muscle capacity.
- Improving shoulder stability and force production.
- Gradually reintroducing powerlifting-specific training.
The initial focus was on restoring mobility of the shoulder and thoracic spine, particularly shoulder external rotation, internal rotation, elevation, thoracic extension, and thoracic rotation. Strength development was approached through fundamental movement patterns, including pushing, pulling, raising, carrying, and throwing activities, with a greater emphasis on unilateral training to address deficits in the affected left shoulder.
Phase 1: Mobility Restoration and Early Activation (Weeks 0–4)
Patient education was a key component of rehabilitation. The patient was educated about the nature of the condition, expected recovery timelines, and the role of exercise and progressive loading in facilitating recovery. Additional education focused on optimising sleep hygiene, nutrition, and hydration to support tissue healing and overall rehabilitation outcomes.
Exercise interventions during this phase focused on restoring mobility and reducing stiffness. These included:
- Shoulder external rotation mobility exercises
- Internal rotation eccentric exercises
- Elevation and overhead mobility drills
- Thoracic extension and rotation exercises
- Scapular activation exercises such as prone Y raises and T raises
The primary goal of this phase was to improve movement quality and restore the functional range of motion.
Phase 2: Strength Development and Functional Movement Training (Weeks 4–8)
Once mobility had improved, rehabilitation progressed toward rebuilding shoulder strength and load tolerance.
Strengthening exercises targeted individual muscle groups and included:
- Front raises
- Lateral raises
- External rotator strengthening
- Internal rotator strengthening
As tolerance improved, functional movement patterns were progressively introduced, including:
- Push movements
- Pull movements
- Raise patterns
- Carry variations
- Throwing activities
The objective of this phase was to establish a strong foundation of muscular capacity while improving confidence with upper-limb loading.
Phase 3: Stability, Symmetry, and Return-to-Performance Preparation (Weeks 8–12)
The focus of this phase shifted toward improving dynamic shoulder stability and preparing the athlete for higher-level training demands.
Rehabilitation progressed to closed kinetic chain exercises and advanced stability drills, including:
- Closed-chain shoulder stability exercises
- Windmill variations
- Turkish get-ups
- Overhead banded perturbation drills
Once adequate stability was demonstrated, bilateral strength exercises were gradually reintroduced, including:
- Barbell bench press
- Pendlay row
- Military press
Throughout this phase, the Limb Symmetry Index (LSI) was monitored regularly. A minimum LSI of 85% was required before progressing to higher-level athletic training.
Following satisfactory symmetry and strength restoration, emphasis was placed on improving rate of force development through explosive exercises such as:
- Push press
- Clapping push-ups
- Pull-ups
Phase 4: Return to Powerlifting (Weeks 12–20)
After achieving adequate mobility, strength, stability, and limb symmetry, the patient progressed to sport-specific powerlifting training.
The initial focus was on rebuilding training volume and work capacity through the three primary competition lifts:
- Squat
- Bench Press
- Deadlift
Training loads were gradually increased based on symptom response, recovery, movement quality, and performance. The goal of this phase was to safely restore competitive-level strength while minimising the risk of reinjury and facilitating a confident return to powerlifting competition.
Key Clinical Message
This case highlights that successful return to sport after Bankart repair is not solely dependent on surgical stabilisation. For strength athletes, recovery requires restoration of mobility, strength symmetry, dynamic stability, force production, and confidence under load. A structured, progressive rehabilitation program can successfully bridge the gap between surgery and return to high-performance powerlifting.