Doc, when can I play again?
This is usually one of the first questions asked by any athlete that seeks treatment for a sport-related injury. Return-to-Sport (RTS) is the decision-making process of returning an injured athlete to practice or competition. This ultimately leads to medical clearance of an athlete for full participation in sport.
The goal is to return an injured or ill athlete to practice or competition while minimizing the athlete’s risk for new injury or re-injury. To accomplish this goal, the treating physician establishes a return-to-sports process that includes the following elements:
- Evaluating the injured athlete
- Treatment and rehabilitation of injured athletes.
- Return to sports participation
- Return to competition
- Returning the athlete to performance.
Individual decisions regarding the return of an injured athlete to play will depend on the specific individual facts and circumstances presented to the treating physician.
Evaluation of an injured athlete is the first key step in establishing a diagnosis and directing treatment and is the basis for deciding when an athlete may safely return to practice or competition. Repeated evaluations throughout the continuum of injury or illness management optimize medical care and aids in the RTS decision. Evaluation should include:
- A condition-specific medical history
- A condition-specific physical examination and functional testing
- Medical and radiological tests
- Psychosocial assessment
- Communication with the player, family, certified athletic trainer, coaches, and other health care providers within disclosure regulations.
Treatment and Rehabilitation of the Injured Athlete
Based on the results of the clinical evaluation, a comprehensive treatment approach is developed that includes non-operative and if needed surgical treatment. Rehabilitation of an injured athlete is designed specifically for the individual athlete and facilitates the safe and timely return to practice or competition and includes:
- Address short- and long-term needs for the athlete
- Individualized consultations and referrals
- Sport-specific assessment, treatment and training to restore function of the injured part.
- Sport-specific conditioning.
- Equipment modification, bracing, and orthoses as necessary
- Continued communication with the player, family, certified athletic trainer, coaches, and other health care providers
Returning to Sport and Competition
The decision for safe and timely return of an injured or ill athlete to practice or competition is the desired result of the process of evaluation, treatment, and rehabilitation.
The RTP decision can be a complex process, involving several steps:
- Restoration of sport-specific function to the injured part
- Restoration of sport-specific skills, fitness, and performance
- Ability to perform safely with equipment modification, bracing, and orthoses
- Psychosocial readiness
- Reinjury Prevention
The transition from physical therapy to sport-specific training after an injury as well as injury prevention can be achieved the tailored sports by an individually tailored sports performance program:
ACL Injury Prevention and Re-Injury Prevention
Anterior cruciate ligament (ACL) tears are one of the most common knee ligament injuries. Most ACL tears are noncontact injuries, with about 70% of them occurring without a direct blow to the knee during pivoting sports, such as football, soccer, basketball, lacrosse, or skiing. This is especially true for women, where the highest rates of ACL tears in sports are for women's soccer and basketball. In order to return to sports participation and minimize long-term complications such as development of osteoarthritis, surgical reconstruction or ACL primary repair is required in the majority of cases. As the incidence of ACL injuries continues to increase, it is critically important to try to prevent these injuries, both initially but also to reduce re-injury-risk after surgical treatment.
ACL injury prevention programs have been shown to successfully improve patient's neuromuscular control and lower extremity biomechanics and have been validated to reduce the risk of ACL tears. ACL injury prevention programs are advocated to improve a patient's balance, overall functional performance, strength, and power, and ultimately lead to decreased landing impact forces. Several types of ACL injury prevention programs which have been described. The Prevent and Enhance Performance (PEP) program has been scientifically established as an effective ACL injury prevention program for both ACL injury and ACL re-injury with a reported 88% injury reduction. The program of a twenty-minute alternative warm-up program focusing on injury awareness and avoidance techniques, lower extremity strength and trunk stability, flexibility, progressive plyometrics, and sports specific agilities. PEP significantly improves lower extremity muscle strength and hamstrings-to-quadriceps ratio, decreases valgus knee moments, improves dynamic lower limb alignment, and increases knee flexion angles.