Study Notes

Return to Play

Care must be taken through rehabilitation procedures to ensure that they return in a safe manner so as to minimise the risk of re-injuring a site.

This process involves discussions between the player, coach, team doctor or team/individual physiotherapist to ensure that all parties are happy that the athlete is ready to return to play.

– Indicators of readiness for return to play (pain free, degree of mobility)

Before an injured athlete can return to normal competition, they need to undergo testing to ensure that they are both psychologically prepared as well as being physically prepared.

Testing that needs to be completed should make sure that the athlete has a full range of movement at the injured site as well as freedom in their movements so that the athlete can push the injured part of the body to a high intensity in competition.

Confidence is important for the athlete as they need to be able to put their body in situations that may challenge the injured site.

If they are not confident, they increase the chance of re-injury or poor performance.

– Monitoring Progress (Pre-test and post-test)

Comparing results from pre-tests to those of a post test after the injury was sustained is important to look at the see whether progress has been made.

An example of this would be pre testing the common joints around the body for its Range of Motion (ROM) and comparing those results to the results obtained after injury rehabilitation has taken place.

Before returning to competition, athletes should be required to test the injured site by completing a series of sports specific tests.

An example would be a soccer player returning from a hamstring strain would be required to complete activities increasing in speed, change of direction and intense movements as well as striking a soccer ball.

These tests are designed to look for a response in power, strength, flexibility and proprioception. If the activity cannot be completed in a similar fashion to how it was prior to injury, then the athlete should continue to rehabilitate.

– Psychological Readiness

Part of being ready to return from injury for an athlete is to be confident in their movements and have a positive outlook.

This type of mental attitude can go a long way to preventing the reoccurrence of an injury.

Some athletes feel pressure to play because of external sources such as the media, sponsors or club directors even though they don’t feel confident themselves.

As a result, both of these situations can often lead to an athlete re-injuring their body.

What an athlete is looking for is a balance of motivation, common-sense and a self awareness of their body to return to play safely.

– Specific Warm up Procedures

Elite athletes after injury, will develop specific warm up routines to minimise injury in their chosen sport.

It may need to be more specific to the injured site to ensure that there is blood flowing to that area as well as developing the mentality that everything is going to be okay.

For example, an AFL player who is returning from a hamstring injury will spend more time warming up that area of his body and adding additional stretches to his hamstring and quadricep areas.

It is important that mentally, the athlete knows that they have warmed up in a safe environment and pushed that particular muscle group past what it may be expected to go through in the field.

– Return to Play Policies and Procedures

The decision on when to return to play can often depend to the severity of the injury.

Individuals who do not play at an elite level are encouraged to make a decision based on discussion with their physiotherapist, trainer or doctor to ensure they are okay to play. For a child, parents will often make this decision in consultation with the medical professional.

At the professional level, there are different actions that need to be completed to prove the player is injury free. These types of protocols can include:

– consultation with the appropriate medical professional

– review of x-rays/ scans and medical reports

– rehabilitation discussion as well as preventative strapping advice

– a fitness assessment that would include specific testing

– participation in a range of sport specific movements within a return from injury skills test.

Depending on the sport and the level of competition, different coaches may utilise their own experience and create their own criteria to use on their athletes to determine whether they are ready to return to the sport. They may have a system that allows the athlete to return through a less stressful environment to test the injured site such as a reserve grade game in soccer or rugby league.

Each sport should have a return to play policy that addresses different requirements of the athlete and coach to return to the game.

These include:

– Ensuring the athlete is safe and functional

– Identify the potential risk to safety of others competing

– What are the requirements of the sport and does the injury impact on this?

At all levels, it is important that documents are kept and recorded to cover liability in case of re-injury.

– Ethical Considerations (e.g. pressure to participate, use of painkillers)

There is often pressure for elite athletes to return to play as soon as possible.

They may be trying to hold onto a spot, fighting for a new contract or expected to play the big games.

This pressure often comes from sponsors, fans, the team, which may force the athlete to return to the sport before they are ready.

In younger athletes, pressure coming from parents or coaches may lead to additional injury if the athlete hasn’t fully recovered from their initial injury.

There are some injuries that require compulsory documented procedures (such as concussions) before the athlete can return to play.

There are many different things that may result in pressure being put on an athlete:

– Financial pressure

– Drive to win

– Sponsors

– Fans

The main priority of any athlete should be to maintain their health and wellbeing.

Full Written Notes

Critical question 4: How is injury rehabilitation managed?
Return to Play

Athletes will generally want to return to their sport as soon as possible. Care must be taken, through rehabilitation procedures, to ensure that they only return when they are fit and ready to minimise the risk of re-injury. This process involves discussions between the player, coach, team doctor or team/individual physiotherapist to ensure that all parties are satisfied that the athlete is ready to return to play.

Indicators of readiness for return to play (pain free, degree of mobility)

Before an injured athlete can return to normal competition, they need to undergo testing to ensure that they are both psychologically and physically prepared. Active and effective rehabilitation will ensure the healing process has resulted in a marked improvement to the injured site. Testing should demonstrate that the athlete has a full range of movement at the injured site, so that the athlete can push the recovered part of the body to a high intensity in competition. The athlete should have also developed improved strength and flexibility, which will be evident after basic skill and fitness testing is conducted.

Confidence is important for the athlete as they need to be able to put their body in situations that may challenge the injured site. If they are not confident, they increase the chance of re-injury or poor performance.

Monitoring Progress (Pre-test and post-test)

It is important to monitor progress throughout the rehabilitation phase of an injury. Comparing results from pre-tests to those of test conducted after the injury was sustained will reveal whether any progress has been made. For example, comparing the results of pre-testing, determined Range of Motion (ROM) with those obtained after injury rehabilitation has taken place.

Before returning to competition, athletes will usually need to test the injured site by completing a series of sports specific exercises. For example, a soccer player returning from a hamstring strain may be required to complete activities which focus on speed, change of direction, intense movements and striking. Athletes need to be able to complete these activities without pain and at 100% effort to match a game situation and demonstrate they are ready to return to play.

These tests are designed to assess the power, strength, flexibility and proprioception of the recovering athlete. If the activity cannot be completed in a similar fashion to how it was prior to injury, then the athlete should continue rehabilitation.

Psychological Readiness

In order to be considered fit for play and athlete must possess confidence in their abilities and positive outlook. Mental attitudes contribute significantly to recovery and the prevention of re-injury.

Many athletes want to return to their sport as soon as possible when they injure themselves. Others often feel externally pressured to play due to the expectations of media, sponsors or club directors, even though they don’t feel confident themselves. Both of these situations can often result in re-injury.

There needs to be open communication between the player, coach and sports psychologist to ensure that the athlete is mentally ready to compete again. Ideally an athlete must demonstrate a healthy balance of motivation, common-sense and a self-awareness before they can safely return to the game.

Specific Warm up Procedures

After injury elite athletes will develop specific warm up routines to minimise re-injury. It may need to focus on the injured site to ensure that there is adequate blood flow. They may also incorporate mental exercises to build confidence and reassurance. For example, an AFL player who is returning from a hamstring injury will spend more time warming up that area of his body, completing additional hamstring and quadriceps stretches. It is important that mentally, the athlete knows that they have warmed up in a safe environment and pushed that particular muscle group past what it may be expected to go through in the field. This will reassure the player that they have recovered and are ready to play.

Return to Play Policies and Procedures

The decision to return to play will be impacted by the severity of the injury. Individuals who do not play at an elite level are encouraged to make a decision based on discussion with their physiotherapist, trainer or doctor to ensure they are completely recovered. Parents will often make this decision for child athletes, in consultation with the medical professional.

At the professional level, there are different actions. which must be completed before an athlete is considered ready to play again. These types of protocols may include:

– consultation with appropriate medical professionals
– review of x-rays/ scans and medical reports
– rehabilitation discussions and preventative strapping advice
– a fitness assessment, which includes specific testing
– participation in a range of sport specific movements as part of an injury skills test

Depending on the sport and the level of competition, different coaches may draw on their own experiences to create specific criteria for individual athletes to determine whether they are fit for competition. They may have a system which allows the athlete to return via a less stressful environment, which will put less stress on the injured site, such as assigning them to a reserve grade game in soccer or rugby league. This type of strategy will often be impacted by the type of injury as well as the timing of the competition.

Each sport should have a return to play policy which addresses the different requirements of the athlete and coach, prior to return after an ijury. These include:

– Ensuring the athlete is safe and functional
– Identifying the potential risks to safety of others competing
– The requirements of the sport and whether the injury impacts this

At all levels, it is important that documents are kept and recorded to cover liability in case of re-injury.

Ethical Considerations (e.g. pressure to participate, use of painkillers)

Elite athletes often feel pressured to return to play as soon as possible. They may be trying to maintain a particular position on the team, fighting for a new contract or expected to play during a big game.

This pressure often comes from external sources like sponsors, fans and the team, which may force the athlete to return to the sport before they are ready. Athletes may also experience internal pressure caused by their own expectations about their success, motivation, ambition and self-worth. Unfortunately, these factor may lead athletes to use painkillers or other drugs in an effort to give them the temporary energy or relief they need to play their sport.

Younger athletes are frequently pressured by parents or coaches to perform, which can result in additional injury if they aren’t provided with an adequate recovery period following the initial injury.

Some injuries, like concussions, require the completion of compulsory documented procedures before an athlete can return to play. These kinds of regulations can protect athletes. The pressure to return to play, even a week early, can often result in further injury.

Athletes face a range of external and internal pressures, which may force them to return to play before they are ready. For example:

– Financial pressure
– Drive to win
– Sponsors
– Fans
– Friends and Family

However, the main priority of every athlete should be to maintain their health, safety and wellbeing.