Criteria for Return to Play After An Injury
When is an Athlete Ready to Go Back to Competition?
There are all types of injuries that athletes can sustain while competing in sports. Most athletes will push to return to competition sooner than they should. The risks of returning too early include extending the time of healing, causing secondary damage to injured tissue, and turning and acute injury into a chronic injury.
Return to play from a catastrophic injury is governed by the personal physician of the athlete. Catastrophic injuries include neurological (spinal cord) and brain injury (subdural hematomas, epidural hematomas, and concussion). Athletes under the care of a physician cannot be released to play without the written consent from their physician.
Return to play for musculoskeletal injuries (sprains, strains, tendinitis) are governed by a set of criteria based on objective measurements. These include comparing the injured side to the noninjured side in the following areas:
- Range of Motion
- Strength
- Power
- Functional Ability
Range of Motion
Range of motion is the ability to move a joint through its full range of movement in each movement pattern. The range of motion of each joint is determined by the bony configuration of the joint. Some joints have more movement ability (shoulder and hip) versus joints that can only move in one plane (knee: flexion and extension).
Although knowledge of anatomy can be helpful, an individual can also just compare the available motion of the injured joint to the uninjured side. Move the uninjured side through all of the possible motions and then compare those to the injured side.
The first criteria to return an athlete to play is that the range of motion on the injured side is equal to that of the uninjured side.
Strength
Strength is the second criteria. Strength is the ability to generate force throughout the movement. An injured muscle will not be able to create as much force as the uninjured side. An easy strength test is to instruct the athlete to move through the available range of motion while resistance is applied to the limb. Compare the strength generated on the injured side to the uninjured side.
The second criteria to return an athlete to play is that the strength of the injured side is equal to the strength of the injured side.
Power
The third criteria is to see if the injured limb can produce power. Power is an essential component in sports as it is the ability to generate strength with speed. Most sports require explosive ability. An athlete is not effective if he is just strong. The muscles need to be able to generate strength as quickly as possible.
For the lower extremity, a simple test for power is a vertical jump. Begin with a two-legged vertical jump to see how well the injured leg tolerates a power move. If the jump can be generated equally off of both legs, try a single leg vertical or horizontal jump.
If the athlete can generate the same amount of power from the injured leg as the non-injured leg, the athlete is ready to return to play.
Functional Ability
The last criteria is functional ability. Can the athlete perform the functions necessary for his sport and do it well? Simple tests can be designed by breaking down the skills necessary to be performed by the athlete in their specific position and having the athlete perform the skills beginning at 50% intensity and gradually increasing to full speed.
If an athlete can perform the necessary skills demanded in his/her specific sport, the athlete is ready to return to play.
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