Returning to Play Post Injury

Last blog post, we discussed how  pain during movement can cause compensation issues. Loss of proper movement can manifest in different ways, whether than is with pain or with decreased performance output. When an injured athlete goes through a rehabilitation program, the goal is to get out of pain and back to performance standards. But how do we know when those standards have been reached?

Typically, the cessation of pain has been an indicator that the athlete is ready to return. However, removal of pain is only a small part of rehab; return to play has many factors that need to be considered. The injured tissue or structure needs to be healed. Compensatory motions that developed need to be tweaked back to optimal standards. Strength levels need to return, as does power expression or strength endurance (or whatever specific quality the sport or activity requires). Linear or multi-directional movement needs to return. Sport specific activities need to return. Add in the fact that all this can be in a linear or non-linear progression, depending on how recovery goes and there is much more involved than simply cessation of pain.

In Sue Falsone’s wonderful new book “Bridging the Gap from Rehab to Performance”, she describes the multiple individuals involved in recovery from medical doctors, physiotherapists, athletic trainers, strength and conditioning coaches, and sport coaches. She argues for fluid communication between all these practitioners to best help the athlete return. Within this “athlete centered” model, each practitioner is able to bring their skills to the table as necessary during the athlete’s return. At different times, different skills will be needed. It is only with communication, trust between the entire healthcare team, and allowing each practitioner to bring their skill set to the table at the optimal time within recovery that the athlete centered model really thrives.

At CompPT, our goal as performance experts is to be the bridge from the therapists (be in medical doctors, physical or athletic therapists, etc) to the sport coach. As Sue Falsone explains, both structure and function are important. Too many times athletes get the ok from the therapist that the structure has healed, or they no longer experience any pain and jump right back into sport. However, just because the pain is gone doesn’t mean that ideal function has returned, or that  performance is back to pre-injury levels!

A perfect example is someone who gets a sprained ankle. It may take a few weeks to recover those tissues. However, once the tissue is healed there are lots of questions:

  • Did pre-sprain levels of mobility return?
  • Single leg strength? Is it equivalent on both sides? Did power return?
  • Was dynamic balance lost
  • Did compensation develop on the other side?

None of these questions are answered by the removal of pain!!

(For the fitness geeks, check out Greg Dea’s four part series on the FMS website at https://www.functionalmovement.com/Articles/778/regional_interdependence_and_limiting_factors_to_performance that goes deeper into this topic. Outstanding series!!)

 

The only way to know when an athlete is back to full function is by taking baseline values BEFORE injury. Baseline measures of the athlete’s movement patterns and strength levels are important so when the athlete does need to participate in rehabilitation objective measures of post-injury function can be compared to baseline values. This assists in the goals of rehabilitation to allow the athlete to return fully prepared to handle the demands of the sport. This is yet another reason why I movement screen all my athletes.

Arguably the most important job of the performance coach is to maintain the capabilities of the athlete without delaying the healing of the injured area. Just because someone’s arm is broken doesn’t allow the athlete to sit on the couch! The rest of the body needs to maintain speed, strength, power and sport specific skills so that when the injured structure is healed the athlete is still in game shape. The S&C specialist can effectively determine how to allow the individual to maintain all their other qualities necessary for sport while simultaneously rehabilitating the injured structure.

Around the same time I read Sue Falsone’s book I also received the book edited by David Joyce and Daniel Lewindon titled “Sports Injury Prevention and Rehabilitation: Integrating Medicine and Science for Performance Solutions”. While I am not doing the book justice with a single comment, many of the chapters are akin to Falsone’s idea about comprehensive, integrated recovery. It is another fascinating read into the increasingly integrated ideas regarding an athlete centered model of development. I hope to soon comment further on the ideas and concepts presented within that book and how it affects my work with my students.

 

Remember that health and fitness are not the same. Return of health (no pain) does not equate to return of fitness. Want to return to optimal levels? Head over to the contact me page and get started!!

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