When should you return to sports after an injury?
When an athlete is injured, he/she will face several challenges. This ranges from being restricted from an activity the athlete loves, away from friends/teammates, uncertain of when to return and unsure how to avoid re-injury.
The main principles for recovering from an injury and returning to sport share some parallels across injuries and among different sports.
First, there should be adequate healing time for the injured tissues (muscle, bone, tendon, ligament). Depending on the severity of the injury, you may benefit from consulting with your doctor or physical therapist, who can establish a plan that allows for appropriate time for healing.
Second, pain should be well-controlled. In most cases this means that there should not be pain at rest, with day-to-day activities or during rehab exercises. In certain cases, such as a mild strains, sprains or tendinopathies, mild pain during an activity, that is no worse following—might be acceptable.
Swelling should be minimal to absent. Range of motion should be full or very near. Strength should be full on testing. Strength can be tested with manual resistance, compared side to side, or assessed with a device that will measure force output.
Strength, balance and movement should have progressed through exercise and activity needed for both daily activities (walking, reaching, stairs), athletic activities (jogging, jumping, lifting), progressed from simple to advanced (squatting on 2 legs advancing to squatting on one leg) and more stationary to more dynamic (squats/steps to jumping/agility). Prior to return to sport, a gradual/progressive interval return to play program is often beneficial. This typically involves a step wise plan (eg walk/jog intervals, starting with a putter/pitching wedge and progressing both club length and number of shots, or throwing a baseball from 45ft, progressing toward 120-180ft before moving to a mound).
Once function can be observed as of good quality (good form on squatting, steps, reaching, jumping, lifting) and activities have ramped up, a functional test might be appropriate. Generally, performance on a test will be compared to the non-injured side (a limb-symmetry-index), where 90% or better is usually expected before returning to sports. Examples of these are testing how far or how high you can hop/jump on one leg, or how many repetitions you can control an overhead activity over a set period of time.
Once you’re checking all of the boxes, you can be more confident that you’re returning to your sport equipped for success. For simple sprains and strains, that improve quickly, this process can take a few weeks and for some post operative conditions it may take a number of months. The main points are to be feeling and moving well, to have gradually advanced activities, to assess how you feel side to side and compared to pre-injury and then to advance back into sports when you feel like you’ve gained enough confidence to do so. Your doctor and physical therapist would be happy to help you develop an appropriate plan that you can rely on to get you back in the game.
by Steve Riley, DPT, SCS, Cert MDT