Marcus Rashford’s shoulder surgery: Who makes the final call on a player’s physical wellbeing?

Elite level professional football is rife with injuries, as well as health and fitness concerns.

Players and clubs sit on a large, varied spectrum of acceptable risk and how comfortable they are with pushing on through injuries and discomfort. This naturally leads to the question: who should have the final say over medical decision-making?

In an ideal world devoid of internal and external pressures of players having to perform, coaches having/wanting to win, fan expectations, and so on, the medical team would have full authority and clearance. However, that’s not how it works in the majority of elite football clubs.

Rather, the push and pull between players and clubs is constant and often exists between groups within the club: coaching staff, medical personnel, training staff, etc. In some situations, the players’ desires will be given more weight, in some the medical staff has ultimate authority, in others it’s a more balanced process.

Further, some players are afforded more leeway and trust to play through injuries. A prime example being Manchester United and England international winger Marcus Rashford.

The dynamic forward has played through a slew of injuries for both former manager Jose Mourinho and current manager Ole Gunnar Solsjkaer, earning the reputation of a high-pain tolerance player, willing to sacrifice his own health for the sake of the team.

Under Mourinho, Rashford played through multiple soft tissue injuries including an adductor tear along with an ankle injury that flared up multiple times. After Mourinho was fired and Solskjaer took the managerial reins, Rashford’s penchant for playing through injuries only became more pronounced.

He continued on with multiple lower back (lumbar) stress fractures, a midfoot ligament injury that he picked up against Manchester City last season — which often required him to wear hard sliders during games to tolerate the discomfort — a hip injury that required pain-killing injections, and finally a shoulder injury. That agitation, a “muscle tear” that is either a rotator cuff injury or more likely a shoulder labrum and biceps tendon injury, is one that he has been carrying for at least 18 months; all of which culminated in a very limited showing for Rashford at Euro 2020. 

With Rashford trusted to play through pain and multiple injuries — for extended periods of time — at the risk of his own on-pitch performances (and the public vitriol that often comes with decreased performance) as well as potentially medium to long-term consequences, does that mean he should also have more say when it comes to deciding whether he wants to have a procedure that may or may not be 100% warranted?

That’s exactly what Rashford and the club just went through, with a back and forth over a shoulder injury that eventually led to him getting surgery.

Thank you for all the well wishes. I had my surgery on Friday morning and everything went very well. A little sore but other than that I’m feeling good. Hope you’re all having a great day! ♥️ pic.twitter.com/cUZQpS0wIi

— Marcus Rashford (@MarcusRashford) August 10, 2021

After playing through this agitation during the second half of Man Utd’s 2020/21 campaign, Rashford was intent on addressing the physical issues that he felt restricted his ability on the pitch, most notably the shoulder injury which, according to The Athletic, resulted in a loss of range of motion, impacted his speed, decreased his confidence when going in for challenges, and didn’t allow him to lift heavy weights during gym sessions.

Rashford’s shoulder injury was such that there was a considerable grey area: differing opinions gave him different timelines for a return to play, from as short as six weeks to as long five months (this isn’t unusual with shoulder injuries and the true timeline often only reveals itself after the surgeon is able to see what’s going on).

However, following the conclusion of the Euros, Rashford decided to get the procedure, but the surgeon of choice was unavailable until the end of July. This led to numerous talks between the player and club — namely manager Solsjkaer — to potentially consider alternative treatments and continue with conservative therapy in-house, which would allow the player to still be available rather than miss the first two months of the season. This came to a head in late-July when Rashford returned from holiday and Solsjkaer commented that everything would be resolved “in a few days”.

To note, we don’t know the full context of these discussions nor if they were simply conversational in nature, or contentious. Based on Solsjkaer’s reputation as a player’s manager, I’d lean heavily towards the former.

This begs a few hard questions: when Rashford decided to play through his past injuries, was there a similar, long-winded process when discussing his route to recovery? Or was that decision to sacrifice for the team accepted and normalised over the many times he chose to play? Was the process different in this case for Rashford’s should surgery because he chose his own health over the team, or because the injury simply dictated as much?

These aren’t questions we have the answers to but it illuminates how decision-making may fluctuate based on the circumstances and what is considered good for the club versus what is good for the player.

As I touched on at the beginning of this article, ideally this decision-making would rest with the medical and training staff, but elite football is filled with competing interests and convoluted reasoning, likely far more than anyone in the public will understand — and often by design.

Dr Rajpal Brar, DPT, is a physiotherapist, movement expert, fitness trainer, and mindfulness coach. He runs the LA-based wellness and athletic development/performance clinic 3CB Performance, and you can subscribe to his Youtube channel (which posts analyses of Lionel Messi and more) by going here.