Injury prevention is an important part of keeping your body healthy and happy, but even the most prepared athletes can never eliminate the risk of injury. When facing a spell on the sidelines, it is critical to take the proper steps to get back to 100% and avoid lasting complications. In this new Sports Medicine guide on the topic, I cover the initial reactions you may experience in the recovery process, a 3-part, decision-based model to follow during recovery, and information on maintaining your fitness from the first week through the sixth month.
Whether you are currently injured or not, “Returning to Play” is a process that is essential to every athlete at some point, and knowing how to do so properly will make the process as smooth and effective as possible!
Returning from Injury is a Process!
“My doctor told me I am cleared to play!”
- Who was involved in the decision to clear?
- What information was used to decide?
- How long have they been out?
- Healed injury/surgical repair, or physical ability and condition to play a sport?
Consider which phase “cleared to play” is referring to:
- Return to Participation: Passing, dribbling
- Return to Sport: Playing 20 minutes of a game
- Return to Performance: Playing at 100% ability
“Return to Sport” refers to a process. If an athlete has not been seen by a Physical Therapist, the Athletic Trainer will be the one to dictate guidelines to progress the athlete back to game play.
3-Part, Decision-based Model for Returning to Play
(1) Medical factors/health status
- Example: knee
- Does the knee feel stable?
- Is the quad muscle strong enough?
- Is this a recurring injury?
(2) Participation risk, including Sport Risk Modifiers
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Example: Ankle
- Protecting an ankle sprain with a brace for a certain period of time
- Fear of re-injury
(3) Decision modifiers not limited to the injured athlete
- Regular season vs. playoffs, pressure from parents/players/self
In Clinic vs On the Field Factors:
- In Clinic: MD, PT, ATC
- Strength, range of motion, swelling, functional tests
- Function tests do a better job of ruling out a player from competition than determining readiness (if a soccer player cannot cut, they certainly cannot practice or play in a game). If they can, it doesn’t clarify whether or not they are prepared for training and competition.
- Psychological state: difficult to measure. Typically done with questionnaires OR using the partnership with DU CPEX department of sports psychologists (contact Julie for more information on this).
- On Field: ATC, sports performance trainer, parent
- Limping or favoring one side, lacking power kicking on one side
- Hesitation and avoiding contact
- Message from parents or medical team vs. what you see at practice
- Options for limited practice or game minutes, position assignment
Coaches play a crucial role in progressing the athlete through training and helping to decide when it is time to return to gameplay!
Last but certainly not least, fitness related to Readiness to Play.
- The workload in an individual event (tryouts, practice, game) causes fatigue.
- The overall amount of training and preparation work done before an event causes an increase in sport-specific fitness and physical readiness.
There is a strong predictive relationship between the fatigue: fitness ratio and injury likelihood, AKA…A player who has not completed adequate training is more likely to be injured in a game.
- After an injury, players should be working on overall fitness in conjunction with rehab i.e. a Sports Performance Specialist. UCHealth has a wonderful partnership with Elite Speed, so be sure to reach out to them after an injury to make sure the athlete is preparing for return to play in a wholesome approach.
- Trust the coach to assess number of practices and amount of work done at practices before allowing to play in a game.
- Overuse injuries cannot heal with rest alone. They require gradual recondition of the body part and the athlete.
- Consider factors that interrupt training: vacation, illness, etc…
Examples of expected Return to Sport Times based on injury:
- Acute hamstring injuries: 11 days-4 months
- Ankle Sprains: 3-6 weeks
- Groin injury: <4 weeks
- Knee cartilage repairs: 7-18 months wide range due to variation in procedures
- ACL reconstruction: 9-12 months or more
- Meniscus repair: 6-9 months or more
- Hip Labral Repair: 4-6 months
- MCL Sprain: 4-6 weeks
Takeaways
(1) Being “Cleared” does not mean the athlete jumps back into practice at 100%. This means “Return to Play” in a progressive manner.
(2) Trust the medical professionals and the coach that they have the athlete’s best interest in mind and want to get them back on the pitch just as much as the athlete and parent.
(3) Progression to gameplay is going to take time but trust the process so that the athlete comes back stronger and better than before the injury occurred.
References:
- Schrier I. Strategic Assessment of Risk and Risk Tolerance (StARRT) framework for return-to-play decision-making. Br J Sports Med 2015 Oct;49(20):1311-5
- Creighton DW et al. Return to Play in Sport: A Decision-Based Model. Clin J Sports Med 2010;20(5):379-85
- Blanch P, Gabbett TJ. Has the Athlete trained enough to return to play safely? The acute:chronic workload ratio permits clinicians to quantify a player’s risk of subsequent injury. Br J Sports Med 2016;50:471-5
- Arden, CL et al. Return to the Preinjury Level of Competitive Sport after ACL Reconstruction Surgery. Am J Sports Med 2011:39(3): 538-43
- Czuppon S et al. Variables associated with return to sport following anterior cruciate ligament reconstruction: a systematic review. Br J Sports Med 2014;48:356-64
- 2016 Consensus statement on return to sport from the First World Congress in Sports Physical Therapy, Bern. Arden CL et al.
- Alexandra Laura PT, DPT, SCS, CSCS, Christen Smalley PT, DPT
Find out more about the CRYSC Sports Medicine Program by visiting our website. If you would like more information on natural solutions and the athlete, please don’t hesitate to reach out to CRYSC’s Head Athletic Trainer, Julie Graves, at [email protected].
