What it took for Vasiliy Lomachenko to get back in the ring after shoulder injury

Lomachenko, Pedraza both make weight for MSG showdown (0:51)

Vasiliy Lomachenko and Jose Pedraza make weight for their lightweight title bout December 8th at the Hulu Theater at Madison Square Garden. (0:51)

Lightweight world titleholder Vasiliy Lomachenko tore the labrum in his right shoulder in May, underwent a surgical repair days later and embarked on an intense rehab and training program in an effort to return to the ring this year.

On Saturday he will face Jose Pedraza in a 135-pound unification fight at Madison Square Garden, just six months removed from surgery. To appreciate Lomachenko's accomplishment in getting back to this point, it is important to first understand what the injury involved.

The labrum is a cartilaginous ring lining the socket of the shoulder that helps enhance the depth and stability of the joint. When torn, it can be not only painful but also problematic in that the shoulder can slip more easily off the articulating surface, giving the athlete a sense of instability. In cases of minor damage, the options may include a clean-up type arthroscopic surgery or even just conservative treatment via physical therapy. If there is more extensive damage to the labrum, the treatment requires a more extensive surgical repair to anchor the labrum back to the bone and restore a more normal anatomy.

When Lomachenko injured his shoulder in his May 12 victory over Jorge Linares, he knew right away he had done something significant. He had suffered an instability episode known as a subluxation, where the ball portion of the shoulder (formed by the top or "head" of the humerus or arm bone) slips off the socket (the semicircular glenoid of the shoulder blade), then suddenly relocates back into place. In the course of that event, structures comprising the shoulder, including the labrum, are at risk of injury due to the sudden and extreme forceful motion. Immediately, Lomachenko knew he could no longer throw his right hook, but he elected to continue with the fight nonetheless.

He not only completed the fight, he won, but he knew his arm was not right. Subsequent testing revealed the scope of the damage to his right shoulder which his surgeon, Dr. Neal ElAttrache, described at the time as "extensive."

"A typical tear usually goes from about 2 o'clock if you're looking at the face of a clock down to about 6 o'clock. His goes almost all the way around," ElAttrache noted. On May 30, Lomachenko underwent surgery to repair the torn labrum.

As critical as the surgery was to restoring the normal anatomy of his shoulder, it was the months of rehabilitation that followed that were going to be instrumental in preparing him for a December fight. There are always restrictions early on in the process as to how much motion is permissible and what types of exercise are allowed with the goal being to allow the surgical repair time to adequately heal. Once sufficient healing has taken place, there is the matter of regaining the strength and conditioning necessary to return to the ring. It's not only restoring the power to the punches a fighter throws, it's also building the reactionary strength to absorb what the opponent delivers, whether that comes in the form of direct blows or through the pulling and tugging that happens when fighters lock arms.

After his surgery Lomachenko remained in Los Angeles for just over a week, long enough to undergo initial post-operative physical therapy and get his stitches out, then he returned to the Ukraine to continue his rehabilitation. Throughout the process, he and ElAttrache remained in close contact, often FaceTiming as a transoceanic form of medical rechecks. Lomachenko would demonstrate his shoulder motion and share videos of his activity and ElAttrache would tell him and his team what components he could begin to integrate to progress his rehab and eventually, his training.

At the beginning, the steps were small. For the first three weeks, Lomachenko was not permitted to elevate his arm higher than 120 degrees, or approximately two-thirds full motion. After three weeks he was allowed to elevate his arm overhead and at six weeks he was granted unrestricted motion. His early strengthening was basic; manual resistance exercises and light rotator cuff exercises were permitted but he was not allowed to load his shoulder in ways that would threaten the surgical repair. In addition to the specific shoulder exercise restrictions in the early stages, Lomachenko was not allowed to run for the first month following surgery so as not to jar the repair.

After passing ElAttrache's early criteria with flying colors, he was given permission to increase his workload to more boxing specific activity. Speed work at six weeks, double-end bag work at eight weeks and heavy bag work at 12 weeks. As for the punch that was most problematic when Lomachenko suffered the injury? The powerful right hook? At three months post-op, that was the last item to add back into his repertoire. For the past three months, with everything reintegrated into his workouts, the focus has shifted to training and conditioning, in an effort to be fight-ready by December.

According to ElAttrache, Lomachenko did everything that was asked of him to prepare his shoulder for this fight.

"He has gotten himself into excellent physical shape," ElAttrache noted. As for whether he is at all concerned about Lomachenko's shoulder heading into a fight just six months following an extensive labral repair, ElAttrache, who is also the team physician for the Los Angeles Rams, draws a comparison to NFL players recovering from similar procedures who are often cleared to return to action at six months. "He has been sparring and making heavy contact with his surgically-repaired shoulder since August. I'm not worried about him throwing punches."

It's natural to assume an opponent will target a spot he believes to be vulnerable and so it is likely we will see Pedraza make an effort to come after Lomachenko's right shoulder. It is also something athletes who are returning from injury are prepared for and Lomachenko has no doubt trained with this in mind. The final phase of rehab is always considered to be the return to the ring for a boxer as there is no way to simulate all of the fight conditions -- the noise, the lights, the adrenaline, the unpredictability of an opponent -- making Saturday night's matchup against Pedraza the final box for Lomachenko to check to prove he is all the way back.