We're a full month out from the events of SummerSlam, where Finn Balor experienced the highest of highs in becoming the first WWE Universal champion, then the lowest of lows as he suffered a severe shoulder injury that forced him to relinquish that title the following night on Raw.
As Balor continues his rehab and recovery, the timing seemed right to take a closer look at his injury, what he can expect in his recovery, and the biggest concerns he faces on his road back to performing in the WWE.
ESPN's greatest resource on injury and recovery questions is undoubtedly Stephania Bell, who spends most of her time writing and commenting on football and baseball. She's a co-host of the Fantasy Focus podcast with Matthew Berry and Field Yates, and an expert guest on a growing list of other ESPN programs. We jumped at the chance to pick her brain and give her a chance to flex her expertise in the realm of professional wrestling.
It's worth noting that the following insights are based on public knowledge, including video footage of the injury at SummerSlam, the list of injuries and complications released by Balor on social media, as well as several images that have made the rounds online in the past month. These insights should be viewed in the context of speaking generally about this type of injury, and an athlete trying to return from it.
- WWE (@WWE) August 22, 2016
Tim Fiorvanti: For an athlete with a small labrum tear in the shoulder, what's the typical length of rehab they can expect to face?
Stephania Bell: The majority of small labral tears are associated with a typical dislocation (the most common mechanism is anterior-inferior, where the arm dislocates forward and downward relative to the socket), which would require a few months to return; for most sports the athlete could return within four months, but in the case of elite/pro athletes or higher-risk contact or collision sports, the recovery could take longer.
180* labrum tear
Thorn bicep and pectoral tendon
& Fracture to the glenoid neck socket
(I have it in a jar on my dresser)
- Finn Bálor (@FinnBalor) August 28, 2016
Fiorvanti: As opposed to a smaller or more straightforward tear, which you just described, what happens in a 180 degree labrum tear (like the one suffered by Balor)? How much more work/how different is the work that has to be done by the doctor in making the repair? How does that affect the rehab going forward?
Bell: A 180 degree tear is basically a larger tear. If you consider the socket, also called the glenoid (it's the round portion on the side of the scapula or shoulder blade where the arm bone [humerus] sits). With a surface that's approximately 360 degrees, a 180 tear runs along roughly half of the glenoid. From the surgeon's perspective, it requires more anchors to fix; in the majority of smaller labral tears, it may take three or four anchors to do the repair. For a 180, it could be more along the lines of five to seven anchors.
Each additional anchor extends the surgery time by a few minutes, and given the increased size of the injury and subsequent repair, the athlete's movement is more restricted -- especially in the early phases of recovery, in order to protect the repair. While the time for the actual tissue to heal is about the same, the process of regaining motion, strength and returning to function takes longer. The total recovery for most athletes is likely to be at least 6 months.
Fiorvanti: How is there such extensive damage that all happened from this one bad landing? What does it all mean when you assess the severity of his injury and his recovery time?
Bell: This is considered a high-energy injury. In other words, a lot of force is going through the shoulder at a high rate of speed -- exceeding what the structure can handle. The more force applied, the more damage you'll have to structures beyond the labrum and superficial soft tissue.
Think of a motor vehicle accident as an analogy. At a slow rate of speed, there are lower forces involved in a collision and there's likely to be less structural damage to a vehicle. The bumper might have some damage, but maybe nothing else. In a high-energy collision, the forces involved are greater and the resultant damage is greater, too. Not only is the bumper taken out, but the structural integrity of the vehicle might be compromised in multiple ways.
Fiorvanti: Is it possible that some of the damage could have come from him resetting his shoulder after he dislocated it?
Bell: It's not likely in this case. The damage was probably so significant that relocating his shoulder didn't matter to the end result.
Fiorvanti: What kind of timetable can we expect Balor to be on? Does the figure released by the WWE mesh with actual expectations for an injury like this?
Bell: The timetable remains very fluid depending on the individual. There's a sliding scale of when new activities are added, based on how the tissue appears to be healing and how the athlete is feeling.
Fiorvanti: Immediately after his surgery, Balor was pictured wearing a large apparatus to stabilize his shoulder. Talk to me about its purpose and its function in helping the healing process.
Bell: The brace is called an ultra sling. It positions his arm in a supportive position, while minimizing stress on the surgically repaired tissue. Essentially, it's placing the shoulder in the optimal position for healing to occur by minimizing pressure within the joint to protect the cartilage. It also keeps him from rupturing the tendon in the front of the shoulder, which had to be detached at the start of the surgical procedure so that the doctor could access the injured portion of his shoulder. That tendon also had to be repaired once the rest of the procedure had been completed.
Fiorvanti: Considering the type of physicality he engages in when performing in the WWE, what are your biggest concerns about his long-term health and risk of re-injury?
Bell: The key here is that the injury was able to be repaired. The stability should be reinforced by the surgery and Balor should be able to regain full range of motion and strength (which also helps his overall shoulder stability going forward). If he does, in fact, regain his motion and strength, he should have no limitations in returning to competition.
Naturally, any time you have a serious injury there may be some changes to the joint surfaces, along with the presence of scar tissue that would not otherwise have been there. It's hard to say that he is definitively at any greater risk of re-injury, especially if he fully rehabs and is at full strength prior to his return to the ring.