April 2004 Bulletin

‘Return to play' guidelines

No one likes to be sidelined with an injury. One of the goals of sports medicine is to try to get an athlete back into action as soon as possible. Returning too soon, before adequate healing or recovery, can put you at risk for re-injury and possibly an even longer down time.

With the right game plan for sports injuries, from early diagnosis and treatment to full functional rehabilitation, you can often safely accelerate your return to play.

What does return to play mean?
This refers to the point in recovery from an injury when a person is able to go back to playing their sport or participating in an activity at a level close to that which they participated at before.

A lesson from the pros
Why do professional athletes return to play so much faster? Professional athletes are usually in tremendous physical condition at the time of their injury. This fitness level helps them in many ways because studies have shown that good conditioning can not only prevent injuries, but also can also lessen the severity of an injury and speed recovery.

Professional athletes also get prompt treatment when an injury occurs and this lessens the acute phase of the injury. Early treatment means that there is less swelling, stiffness and loss of muscle tone. In addition, they work extremely hard with a physical therapist and/or certified athletic trainer during their recovery.

They also have a positive attitude. While you may not have access to many things professional athletes have, you can harness the power of a positive attitude for your own benefit during recovery.

Tips to speed your recovery

A recovery plan
Recovery from an injury involves a series of logical steps from the time of the injury until you are able to be back on the field or court. Each step should be outlined and monitored by your physician and physical therapist.

During the acute phase, the focus should be on minimizing swelling. This involves the RICE formula: Rest, Ice, Compression and Elevation, along with a limitation of activities. Depending on the type and severity of your injury, treatment may also involve surgery, bracing, or even casting.

During this period, it is very important to maintain overall conditioning while the injury heals. Creative techniques can be used to safely work around the injury. For example, a runner with a leg injury can often run in water or use a stationary bicycle to maintain conditioning. Even if one leg is in a cast, the rest of the body can be exercised by performing strength-training exercises. Do not wait until your injury is healed to get back into shape.

In the next phase of recovery, you should work on regaining full motion and strength of the injured limb or joint. Your physician, therapist or certified athletic trainer should outline an exact plan. For most injuries, gentle protective range of motion exercises can be started almost immediately. Muscle tone can be maintained with the use of electrical stimulation or simple strengthening exercises.

When strength returns to normal, functional drills can be started. This may include brisk walking, jumping rope, hopping or light jogging for lower extremity injuries and light throwing or easy ground strokes for upper extremity injuries. Specific balance and agility exercises can bring back coordination that may have been lost in the injury.

Once you have progressed with motion, strength, endurance and agility, and are tolerating functional drills, you can try higher levels of functional tests and drills that incorporate sport specific movement patterns on the field or court. This is monitored by your physical therapist or certified athletic trainer. You may find that tape, braces or supports help during this transition time.

Only when you are practicing hard without significant difficulty and the healing has progressed to the point where the likelihood of injury or harm is low, are you ready to return to play. During these final phases of recovery, you should be closely monitored and special attention should be given to adequate warm up before and icing after activity.

A word of caution
Following the rational progression of recovery not only lessens the chance of re-injury but also assures that you will be able to perform at your best when you return to play. All too often, athletes think they are ready to return as soon as the limp or the swelling subsides. They may feel good, but they are probably only 70 percent to 75 percent recovered. This invites re-injury.

Sports medicine experts are working on ways to help athletes get as close to 100 percent recovery from injuries as possible, as quickly as safety allows. There is often tremendous pressure to get the athlete back as soon as possible, but the athlete's health and safety must be placed above all other concerns.

A systematic recovery plan is successfully used every day, at all levels of play, from the recreational athlete to the elite professional or Olympic athlete.

This sports tip is a joint endeavor of the American Orthopaedic Society for Sports Medicine and the National Athletic Trainers' Association to promote the health and safety of athletes. This article for Your Orthopaedic Connection was prepared in cooperation with the American Orthopaedic Society for Sports Medicine. Find more tips on preventing sports injuries at: http://orthoinfo.aaos.org.

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