Return To Sport – Foundation & Concepts

This topic is THE most talked about subject in all of sports medicine & rehab…and has been for some time now.  Once an athlete is injured, all anyone can talk about is “when can they play again?”  Athletes (and the rehab professionals working with them) want to get back to whatever sport as soon as possible.  There is enormous pressure to get back sooner and sooner and miss less and less playing time.  We are all looking to cut that time loss down – but more importantly, we want to know when the athlete is ready to go back…safely and effectively.injury_football

No one. Let me repeat, NO one has figured out the solution to this puzzle.  Various thoughts & opinions are floating around in the rehab world, and I have learned a great deal from many of them.  My collaboration with numerous practitioners and my experience working in sports medicine about how to best approach this very topic has lead me to take away two main points:

  • First, if an athlete is not sure they are ready to go back, they are not ready to go back
  • Second, when an athlete says they are ready to return they have to prove to me AND TO THEMSELVES they are ready

In other words, if I have not taken the athlete through a battery of tests & gathered objective information about things like: range of motion, body weight control, symmetry, single limb force acceptance, sport-specific strength, power and agility testing, I could not possibly have any real way to determine his/her readiness.

Injury risk is difficult to determine. We need to use the best evidence/research available to generate readiness to return to activities and overall risk…based on multiple musculoskeletal assessments, NOT educated guesses.

Fingers crossedTo help guide us, we need to define a couple of things first.

  1. What is an injury?  Who needs to undergo comprehensive testing? This is not an agreed upon definition, but let me offer a couple of suggestions…an injured athlete is:
    • any athlete that is held out of participation by a physician
    • any athlete that has missed 5 consecutive events…Organized Team Activities (OTAs) – practices and/or games
  2. What does Return To Play (RTP) mean?
    • RTP refers to the point when a previously injured person is able to go back to playing sports or activities at a pre-injury level.
  3. What are sports teams and rehab professionals doing currently?
    • Currently, everyone does their own thing.  There is a lack of consensus, communication and understanding within the realm of Sports Medicine to best determine readiness for return to play with minimized risk of injury.  Some of the current concepts used to determine this readiness include:
      • “Acceptable” pain
      • Full Range of motion and strength
        • How are we measuring this?  What are the normative values?
      • Biological healing time: Graft integrity, ligament tissue healing, fractured bone restored, etc.
      • General functional abilities
        • This is ridiculously vague & can vary widely among clinicians
      • Watch the patient jog, jump, land, cut, figure 8
        • All are challenging to objectify, seem to be “quality-based”, vary among practitioners AND are 3-4x body weight

As you can see, this is generally a good set of guidelines, but nothing in the way of offering specifics.  Everything above is very generic and vague.

How should we determine this readiness?

Check ListWell, my thoughts on the matter:  Injured athletes should be required to reach a given set of criteria in order for all practitioners, athletes, parents & coaches to understand what elements determine readiness to return to sport AND help to minimize subjectivity.  That makes sense right?  I don’t arbitrarily say, “when I feel you are ready, you can return.”  It should be something they can shoot for and something they can see how close or far away they are from achieving that criteria.  Pre-established.

The Mission:

To develop and implement a comprehensive process to take an athlete from injury to readiness to return to their sport or activity with minimized risk of injury/re-injury.

This is where I will pick back up in future posts – Development of a comprehensive program (or programming).  I hope I have set the foundation for the concept(s) of Return to Sport readiness.  In future posts I will elaborate on the given criteria I (along with many of my co-workers) use to apply multiple objective measures and minimize subjectivity as much as possible.  Until then, keep working to get yourselves and your clients better.