{"id":402,"date":"2009-11-14T08:51:59","date_gmt":"2009-11-14T15:51:59","guid":{"rendered":"https:\/\/blog.brianschiff.com\/?p=402"},"modified":"2009-11-14T09:11:43","modified_gmt":"2009-11-14T16:11:43","slug":"sports-injury-return-to-play-guidelines","status":"publish","type":"post","link":"https:\/\/blog.brianschiff.com\/?p=402","title":{"rendered":"Sports Injury Return to Play Guidelines"},"content":{"rendered":"

I am often asked when is it safe to go back to play after an injury.\u00a0 In most cases, I am dealing with lower body or back injuries with my athletes, so for the purposes of this post, I will address a lower body functional return to play paradigm.<\/p>\n

The tricky part about this question is that no two injuries are created equal.\u00a0 Sure, I will be the first to acknowledge that I have general approaches to certain injuries and have a sense\u00a0of how long it should take most of the time.\u00a0 But, over the past 13 years I have seen enough irregularity and differences to say that everyone heals and recovers differently.<\/p>\n

For example, I have had athletes with a simple grade 1 ankle sprain not go back to sport for 6 weeks, whereas those with much more severe grade 2 or even grade 3 sprains go back in much less time.\u00a0 Why?\u00a0 There may be several reasons including compliance, body structure, previous medical history, fitness, pain tolerance, and the quality of the rehab to name a few.<\/p>\n

In the end, rehab professionals and strength coaches must have sound knowledge of pathophysiology, tissue healing, and program design that ensures maximal progression with optimal tissue loading.\u00a0 Messing up the stress gradient (too little or too much) will slow the return to play process.\u00a0 Below are some major milestones my athletes must clear in order before we even get to what I term “functional rehab” or preparatory movement prior to controlled practice:<\/p>\n

    \n
  1. Full active range of motion<\/li>\n
  2. Normal strength on muscle testing<\/li>\n
  3. Normal walking gait<\/li>\n
  4. Symmetrical squat and lunge patterns<\/li>\n
  5. Single leg squat (back, hip or knee injury) and\/or calf raise (ankle injury) within normal limits compared to uninvolved side<\/li>\n
  6. Single leg hops in place x 10 equal to uninvolved side with no pain or instability<\/li>\n
  7. Normal running gait on treadmill x 5′ without pain or instability<\/li>\n
  8. Lateral gait cycle within normal limits (shuffle, carioca and cross stepping)<\/li>\n
  9. Planned and predictive controlled agility without pain or instability<\/li>\n
  10. Low level plyometrics in 3 planes without pain or instability<\/li>\n<\/ol>\n

    After moving through this fundamental progression (may take days or weeks), the athlete may then begin to perform more demanding neuromuscular work.\u00a0 This would involve more rotational work, full intensity sprints an cutting, and gradually the transition to reactive agility and speed drills.\u00a0 Once the athlete completes this process, he or she is ready for controlled practice.<\/p>\n

    This is an area where I see student athletes get in trouble. They get “cleared” so to speak by the MD and go back to practice.\u00a0 Cleared to a coach means full go, right?\u00a0 The athlete should ease back into practice even after a carefully prescribed rehab plan like the one I just laid out.\u00a0 However, too often, I see athletes rushed back to full practice too soon.\u00a0 In the case of soft tissue and stress reaction injuries, this often sends them back to the training room or sideline much sooner than the coach or athlete would like.<\/p>\n

    What is the answer?\u00a0 Controlled practice progressions with the idea of first increasing volume (total minutes) prior to restoring maximal intensity.\u00a0 Athletes know what is hard and what hurts.\u00a0 We just need\u00a0to communicate with them.\u00a0 Allow them to do the easier drills and fill up time with those prior to ramping up the intensity for the entire practice.<\/p>\n

    Let’s take soccer as an example.\u00a0 Dribbling, passing and light shooting are lower level drills.\u00a0 In contrast, set pieces and small sided games are much more demanding.\u00a0 Athletes and coaches must use discretion when returning form play to avoid re-aggravating an injury.\u00a0 Measuring pain before, during and for 24 hours afterward is crucial in determining how the body is absorbing the force and responding to the training stress.\u00a0<\/p>\n

    If soreness is lingering for more than 24 hours, this is a red flag that the volume and\/or intensity is too much.\u00a0 I educate all my parents, coaches and athletes to follow this simple 24 hour rule.\u00a0 I have found if you do, you end up with predictable results in terms of recovery and return to play.\u00a0 So, if you have suffered an injury, be sure to consider moving through a set functional progression and be sure to used a controlled return to play approach to ensure you make a full recovery.\u00a0 Have questions?\u00a0 Leave a comment or shoot\u00a0me an email.<\/p>\n","protected":false},"excerpt":{"rendered":"

    I am often asked when is it safe to go back to play after an injury.\u00a0 In most cases, I am dealing with lower body or back injuries with my athletes, so for the purposes of this post, I will address a lower body functional return to play paradigm. The tricky part about this question […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[7,8,5,26],"tags":[424,42,41],"class_list":["post-402","post","type-post","status-publish","format-standard","hentry","category-injury-prevention","category-rehab","category-sports-performance","category-training","tag-rehab","tag-retrun-to-play","tag-sports-injuries"],"yoast_head":"\nSports Injury Return to Play Guidelines - Brian Schiff's Blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blog.brianschiff.com\/?p=402\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Sports Injury Return to Play Guidelines - Brian Schiff's Blog\" \/>\n<meta property=\"og:description\" content=\"I am often asked when is it safe to go back to play after an injury.\u00a0 In most cases, I am dealing with lower body or back injuries with my athletes, so for the purposes of this post, I will address a lower body functional return to play paradigm. 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