Return to sport – how to do it the right way
By Carson Lux. When an athlete is recovering from an injury, the journey can be filled with great hopes, crazy emotions, and fears, but the one thought that dominates his or her recovery is “Will I be able to return to my sport?” There are several key components to an athlete’s successful return to their sport.
Recovery is a “team sport”
The first thing the athlete must realize is that a successful return to sport (RTS) requires the athlete to give up a vital component of what makes them successful: control. Athletes at all levels, and especially those at the highest levels of their sport, craft a self-image based on their athleticism and ability to control their bodies. However, once that athlete sustains an injury, the ability to control their body and do the amazing physical tasks they once did with ease is greatly reduced if not gone. The athlete needs a team they trust—surgeons, therapists, athletic trainers, coaches, performance specialists, parents—to help them understand that full recovery is possible. That team is responsible for giving the athlete expert guidance and care to realize a complete RTS.
Some injuries, such as ankle sprains, are very straightforward and the recovery process is quick. Other injuries however are much more complex, such as ACL tears, rotator cuff tears, and hip impingement, which can take several months to rehab properly. In the complex cases requiring surgery, the athlete needs to be patient and rely on the guidance of their surgeon and therapist to avoid pushing too hard too soon and causing delays in proper recovery. For example, a general guideline is that surgically repaired tissue takes 6 weeks to achieve primary tissue healing. At this point, normal non-sport activities can be resumed; but in the case of the ACL reconstruction, the graft isn’t fully healed for another 4-6 weeks after that.
Restore the basics FIRST
Once an athlete feels “normal” with the basics of life, like dressing, walking, stair climbing, and reaching overhead, they have to continue the mundane work that makes therapists and doctors excited: recovering full movement of the joint, achieving normal strength of the muscles around the joint, or walking without any sign of a limp, to name a common few. Too often like toddlers, athletes literally want to run before they can walk. This mindset can lead to problems later in their recovery, particularly when they forget…
The body works as a whole
Successful RTS involves a key piece of education for the injured athlete: Even though one area is injured, the entire body is involved in restoring and maintaining proper movement. It’s always insightful to see how an athlete reacts when they improve movement restrictions in their ankle or thoracic spine and then see the improvement it can cause in knee, hip, and shoulder movement and in overall function.
We as therapists cannot allow athletes to create function on dysfunctional movement platforms—the equivalent of building a beautiful home on a crooked, cracked, and unstable foundation. The job of a good therapist is to get the recovering athlete to move so well and efficiently as a complete human “machine” that the risk of reinjury is greatly reduced.
Do your “homework” and pass your test!
When an athlete has moved into the latter phases of therapy, that’s when the “real” fun begins. At this point the athlete is well past the initial limitations in joint and global mobility and strength and has mastered basic activities such as squatting and lunging. Now we work to address sport-specific movements and make sure they have regained the “movement competency” necessary to return to competition.
Movement competency involves breaking down the athlete’s specific movement requirements for their sport and making sure these are biomechanically sound and tied together correctly with the rest of their body. For example, multi-directional jumping on one and two legs, planting and cutting movements, throwing mechanics corrections, and plyometric activities to help regain lost power and explosiveness, among others. In the context of rehab, the exercises in this phase are more like an actual training program with variation in exercises and training volume.
It is important to note that as therapists we should work in conjunction with the athlete’s coaches and performance specialists; we’re not teaching the athlete specific tasks of their sports, but the underlying high-level movement patterns that make up these tasks, allowing them to be safe and repeatable.
Near the end of this phase is when specific functional testing is done on the athlete to determine their actual fitness to RTS. There are various standardized tests for some injury protocols such as ACL reconstructions, but many rehabilitation protocols are sorely lacking in this area. The key to a good RTS testing procedure involves multiple functional movements that challenge the athlete’s control, balance, and power.
To ensure the athlete is truly ready to RTS, the final phase of testing should involve some type of fatigue protocol. Many athletes sustain their injuries later in practice or competition when they’re fatigued, which can lead to mechanical breakdown of movement or the literal breakdown of newly repaired tissue. Having the athlete go through a brief, intense battery of jumping, agility work, and short sprints prior to the actual RTS testing is of immense value. Testing in this manner teases out any remaining issues that may result from simple fatigue. Once the test is successfully completed in a fatigued state, the athlete should feel confident in their ability to step back into competition and be as “bullet-proof” as possible.
Athletes need to remember above all else that their progression in therapy is based upon their ability to achieve specific physical benchmarks throughout the course of their rehabilitation, not a certain amount of time passing from their injury or surgery. Recovery and therapy are not “one size fits all” and should be customized to the individual athlete to ensure the best possible outcome and return to competition.
About the author
Carson Lux is a physical therapist in Naperville, IL for Athletico Physical Therapy. He has over 30 years’ experience treating orthopedic and sports medicine conditions across a spectrum of athletes from the Olympic and professional ranks to the intercollegiate and high school levels. He is the program head of Athletico’s Movement Performance Project and is a clinical specialist in the treatment of Hip Preservation, ACL, and Overhead Athlete patients. Carson has lectured on multiple topics including movement assessments and advanced exercise prescription in the rehab setting and is passionate about understanding human movement and optimizing human performance.