In the age of sports where little kids as young as 9, travel across the country to play in tournaments against other 9-year-olds, injuries are inevitable. The business aspect of sports puts greater stress on individuals to return to sport as quickly as possible. Understandable for professional athletes, however, for youth athletes that is very unnecessary to have those conversations. Being that we have more and more youth athletes in our office, let’s have a discussion about what is an appropriate time to return to play following an injury. Parents, this one is for you.
After any injury, one of the first thoughts is “When will I be back to 100%?” or “When can I get back to doing X activity?”. The very educated doctor's answer is: IT DEPENDS. It is not the clear cut when it comes to pain and injuries and there are too many factors to be able to answer that simply. However, there are certain criteria that we consider prior to allowing an athlete to return to sport. Before we answer this, please keep in mind we do not take in mind how much you paid for your league or tournament, or how badly they want to play. The athlete's safety is the utmost priority.
Our answer to “when is it appropriate to return to X activity”
What should be clear from the start is that restoring an athlete to competition after an injury is all about restoring function to similar levels to pre-injury status/performance. It is not simply based on a timeline. Although timelines are important, function over time is the biggest priority. Before returning, the athlete should be:
- Pain-free in movements particular to sport (Ie. pain-free throwing)
- Strength and power is restored to as close as possible to pre-injury levels
- Neuromuscular and metabolic needs necessary to sport are achieved
- Confidence in movement pertaining to sports
The easiest example to understand how this process works is to compare a simple ankle sprain to a post-surgical ACL reconstruction. For the simple ankle sprain, we would focus on the initial inflammation and pain management and introduce loading the joint through movement and exercise. Depending on the severity, this could take about 1-3 weeks. Outside of asking the patient how they feel subjectively, we would perform objective tests to determine muscle strength, joint-specific movement, global movement, functional testing such as running or jumping, and then finally sport-specific movements such as cutting or back peddling. If the patient could not perform the functional testing or sports-specific testing, do you think it would be ethical and smart to say, “yes, go ahead and play this weekend.”. No, of course not. Sure, could some athletes “push” through pain, absolutely; however, there is a process we must follow to determine if it is safe to play.
For the ACL-R, we would have an in-depth return to sport protocol with a lot more objective measurements. This process would take up to a year and would have guidelines to follow and physical criteria to attempt to meet prior to moving on to the next step. We love to use the Ohio State Sports Medicine rehabilitation protocols and they have been very helpful to send to patients so they can understand the process and patience of the recovery. This makes our lives easier as the clinician so the expectations are understood and the idea that because Adrian Peterson returned to the NFL after 6-months of ACL rehab, that does NOT mean you’re 16-year-old daughter will too.
In essence, patience and trusting the process following an injury takes some understanding as well as communication in regard to expectations with your clinician. What we do is not magic, but we can absolutely help achieve timelines and get athletes back to their sport in a safe and timely manner.
If you’re an athlete struggling to get back because of an injury or dealing with a nagging injury, Strength & Spine is THE place to be for athletes.
Let us help you get back to performing your best.
Dr. Cameron Gholampour DC, MS, CCSP®
International Certified Sports Chiropractor
Strength & Spine Chiropractic