How to Decide When to Return to Play

“Return to play refers to the point in recovery from an injury when a person is able to go back to playing sports or participate in an activity at a pre-injury level¹.” An injury can be minor and not require you to stop competing or major and require a long rehabilitation training program. Often the major goal of a long training program is when to return to play. When you and your therapist are setting goals for your return to play it is important to make a plan, consider the speed at which you need to recover and what can be done to prevent the injury from coming back.

When an injury happens, you can be forced to leave your sport and focus on your recovery. This is a great opportunity to fine tune your mental drills and skills to prepare you for your return. It can be a frustrating time but it can also be a chance to improve in your sport without actually doing it. During normal practice time you can read up on your sport, analyze game footage and do whatever you can to learn about your injury². Imagery is a great way for you to stay in the game. You can practice rehearsing your sport specific skills, plays, strategies, or a series of plays during a rehab session³. Mental practice can be done many places including when you are icing or just lying in bed.

This mental active rest gives your body time to recover which is very important as a young athlete; you are still growing and any injury can affect your normal growth. Be sure to give your body the time it needs to rest and recover so you do not permanently cause harm. How much rest and rehab is enough? When you are practicing hard without any significant difficulty, and your healing has progressed enough that you will most likely not hurt yourself again, then you are ready to return to play¹. Here are some general goals to consider for returning to play.

• Normal range of motion (ROM). Compare if you can to your uninjured side.
• Decrease in acute pain to near zero
• Decrease in swelling to near zero
• Strength of the affected part at 80 – 100% of the opposing body part
• 80 – 100% return of balance and coordination
• The ability to run without a limp (lower body injury) or able to throw with proper mechanics (upper body injuries)

Your athletic therapist or physiotherapist can use different types of fitness testing to determine your readiness to play. Here is a simple progression of exercises that test your ability to return to your sport.

1. Walk with no limp.
2. Jog with no limp.
3. Sprint with no limp.
4. Figure 8 jog and run with no limp.
5. Quick cut "zig-zag" running with no limp.
6. Double leg hop.
7. Single leg hop.
8. Non-contact sport specific drills.
9. Contact sport specific drills, and
10. Return to competition.

Your therapist wants you to help you return to your sport as soon as possible. This requires that he or she be safe and effective in healing and training your body. Recovering from an injury cannot be speeded up unless it is safe to do so. The best tools to make your rehab progress quickly are actually learned before you get hurt. General overall fitness makes your injury less of an impact on your training for sport. You can recovery faster and prevent more injuries if your body is well conditioned.
Another thing to consider when an injury happens is how fast you get medical attention. If you get treatment quickly the first phase (acute phase) of your injury will take less time. The more time you spend with your therapist immediately after your injury, the less time you spend with him or her during recovery. This health care professional will help you get back on track but some areas that you can concentrate on to speed up your recovery are:

Concentrate on nerve/muscle training

• Your rehab workouts should be an educational experience in teaching your body to effectively generate muscle activity².

Conserve energy

• Focus on the task at hand and do not feed on the emotion of competing and you will be able to tap your mental reserves so you can think more clearly and perform better².

Forget the past and focus on what you can do now

• Each day is an opportunity to accomplish small goals that move you forward. Take each day as an opportunity to make a small step forward.
• “If you try to jump right back in, it is very easy to cause further damage, delay the healing process or burn yourself out².”

Prevention is the key

• While you learn new skills also learn ways to adapt and improvise. If you are learning to Olympic lift, also learn the safe way to drop the weight if you cannot lift it completely. Creating a safe training environment gives you confidence in your abilities and allows you to train better².

When you have reached the maintenance stage of your rehab program, you are ready to compete again. This stage also helps you keep competing safely by including exercises that help you prevent re-injury. A good rehab program includes control abuse to help correct the factors that lead to the injury⁴. A major factor for younger athletes is too much participation. As a general rule you should not train more than five days per week, participate in only one sport a season and take two to three months off from that sport every year. Remember that your bones and muscles are still developing and you cannot handle the same stress as an adult so you need to take time away from your sport.

Returning from an injury is successfully done when you have a recovery plan, understand when to speed your recovery and include prevention maintenance in your training program. Overall you need to maintain balanced physical conditioning and make sure that injuries are recognized early and treated promptly. To make treatment effective you need to participate in a full functional rehabilitation program and stay fit while injured. Getting injured can be overwhelming but if you stay positive and maintain an upbeat mental attitude you will return to play in no time.

1. Your Orthopaedic Connection: Return To Play. . http://orthoinfo.aaos.org/topic.cfm?topic=A00365. Accessed 7/7/2008, 2008.
2. Girevik Magazine- Training Through Illness and Injury. . http://www.powerathletesmag.com/archives/seven/injuries.htm. Accessed 7/3/2008, 2008.
3. AASP – Mentally Preparing Athletes to Return to Play Following Injury. . http://appliedsportpsych.org/resource-center/injury-&-rehabilitation/articles/mentally-preparing. Accessed 7/7/2008, 2008.
4. Principles of Rehab. . http://www.healthsystem.virginia.edu/internet/pmr/prinofrehab.cfm. Accessed 7/7/2008, 2008.

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