When do I attempt a return to sports following an injury? This is one of the hardest decisions for therapists, doctors, and athletic trainers to make.
In reality, there is no hard evidence to support the decision either way. There are, however, a number of return-to-play testing protocols that have been created to help guide our decision.
Potential for Re-Injury
The biggest concern for a medical team is the potential for re-injury of the same body part or an injury to a different, but connected, body part. You see this routinely in professional and college sports – a player is out all year because of an ACL tear and then (finally!) returns for a couple of games, before exiting again with a hamstring, groin, or calf strain. Surrounding musculature is at greater risk for injury if the athlete hasn’t fully returned to pre-injury status.
Complicating the issue is the trend toward shorter rehab stints and early release from recovery programs. Most post-surgical protocols call for a return to sports no earlier than one-year post-op, but our rehab timeline often ends at 3-6 months. That leaves an athlete, coach, and training staff with 6-9 months before earliest recommendations. Of course, some athletes are ahead of schedule and can accelerate their return. But how do we know? And when is it safe?
Functional Testing Post-Injury
All athletes should be involved in functional testing post-injury. Our best indication is judging an athlete against themselves, either comparing them to pre-injury performance or to their uninvolved side. This holds true when dealing with issues from strains to surgery to concussions. Considering specific sports requirements is also essential. For example, a volleyball outside hitter should be judged differently than a soccer defender, pitchers differently than wrestlers.
Follow these Rules
Following a few simple rules can help a medical team decide whether a patient is ready to return to play:
There should be an essential resolution of symptoms. This does not necessarily mean that the athlete is entirely symptom free, but acute pain or symptoms that indicate bony involvement or ligament damage should be eliminated. Concussion symptoms should be eliminated. Muscle soreness, stiffness, or lack of endurance might still be present through transition periods.
The athlete should be able to make all movements necessary for their sport and position. Wrestlers should be able to bear weight through all limbs, throwers should be able to show full motion in all directions for the shoulder, etc.
Athletes should be able to demonstrate a base-level of core strength and control. They should be able to fully and non-painfully engage all necessary musculature.
Functional testing measures should approximate 90% of the uninvolved side or pre-injury status. Single leg jump scores for height and/or distance, memory recall, cognitive processing, and speed and agility tests should approach symmetry. Athletes should pass any return-to-play testing protocols used by their medical team for specific injuries or body parts.
The athlete should tolerate practices, starting at simple drills and progressing to scrimmages, without new or returned symptoms that are judged to be a concern.
We can’t predict the future
While these rules can push us toward the best decision, it’s also important to remember that nobody can predict the future. Sports are high-velocity, high-load activities and athletes aren’t always able to achieve the “best position” with all movements. Many athletes can return at less than full performance, but not all tolerate full sports activity with remaining limitations. A combined decision between the medical team, athlete, coach, trainer, and parents is essential for long-term success.