Return To Play After Injury

An essential part of diagnosing and treating sporting injuries is navigating a successful return to play.  If you're a footballer, this means your first game back.  If you're a runner it might mean returning to full training volumes.

It’s theoretically possible to return to play as soon as you’re able to stand up again, but obviously there’s a high chance of injury aggravation &/or recurrence. So, successful return to play isn’t just getting back on the field, but also doing our best to make sure:

• your performance is up to standard
  
• and the injury doesn’t happen again.
  

For a lot of injuries we can agree on a rough timeframe of recovery based on our previous experience with similar injuries, and a known pattern of tissue healing.  However, time alone is only a small component in determining successful return to play.

This article (Creighton, 2010) outlines the extensive range of other considerations for negotiating a successful return to play:

After assessing an injury I like to outline the milestones that are necessary to achieve a successful return to play.

Physical factors may include:

• Pain is tolerable
  
• Swelling / effusion has gone down
  
• Strength is similar to the other side
  
• Range of movement is similar to the other side
  

This guides our treatment & gives us goals to work on with rehab, which may include: 

• Stretches
  
• Strengthening
  
• Tissue healing
  
• Pain modulation
  

Functional milestones need to be achieved sequentially. You need to pass one level to get to the next. 

Roughly, this might look like:

• Walk without limping &/or pain
  
• Hop
  
• Jog
  
• Run
  
• Sprint
  
• Non-contact training
  
• Train with contact
  
• Play
  

Progression through each of these functional stages may include:

• Increasing volume
  
• Increasing intensity
  
• Introducing hills
• Second daily running
  
• Two days on, one day off
  
• Daily running

By the time we return to the playing field we have confidence in the injury because we’ve done the work.  Doing the rehab in a graded, progressive manner serves two purposes:

1). The exercise is conditioning, or “mechanotherapy”, to aid recovery.

2). It serves as a screening program, answering the question “am I OK to return to play?”.  

Doing the rehab gives us confidence that you’re OK to do “Z” because you’ve successfully completed “W”, “X”, & “Y”.

Here is a graded, progressive running program I like you to progress through before returning to training.

Here is a graded, progressive rehab programs for throwing & a similar rehab program for kicking.

Injury Recurrence

Successful return to play isn’t just about getting back on the paddock.  

We know the biggest risk factor for any injury is a previous history of the same injury.  That means once you’ve had an injury, you’re at risk of re-injury.  

So successful return to play must include rehab aimed at preventing the same thing happening again.  This might include specific stretching, strengthening, taping, bracing, proprioception, or skills.  The job is only half done if you’re still at risk.