The biggest risk factor for injury isn’t over-training or lack of fitness, poor coaching or poor preparation. It isn’t even reckless play. The biggest predictor of injury by far, is previous injury. Kids who’ve been injured before and are attempting to return to play are at significantly increased risk of re-injuring the same knee, ankle or foot. Their incidence of injuring the matching part on the opposite side is increased, too, thanks to the body’s natural tendency to compensate for instability and weakness. (And we all know how concussion predisposes to future concussion.)
We can’t prevent all injuries nor protect them from all recurring or repetitive injuries, but we must be smarter in helping them manage their return to play. We would do well to think of our time with newly returning players as a “rehab stint with the minor league club.” As their managers, here are some things we can do to help reduce the risk of re-injury as players return to their sport:
Doctor’s “release” doesn’t mean they are ready to go back at full strength.
“Medical clearance” may be the most misused note in high school. When an athlete gets “cleared” by a doctor, it signifies that a medical professional thinks everything has grown back together and reasonable strength and range of motion have returned. This does not mean the athlete is ready for a full return to competitive play. It means they have full capability to walk to class – provided no one shoves them into the lockers – and return to “regular activities.” Full contact club sport is not a “regular activity.”
Caution. The elephant in this room is this: numerous athletes have confirmed to me that they have “shopped around” for a doctor who will clear them to play. If one refuses, there’s another one who will sign. If they want to play, they’ll find a doc who will let them. Makes you wonder, doesn’t it?
“Standard” time for return to play after an ACL reconstruction is 6 months. Some players return as early as 4 1/2 months, and these players will brag about their early return after “working their tails off.” Sports medicine docs who are experienced with rehabbing ACL’s currently advise waiting at least 9 months, and they say that a year is better to decrease risk of re-injury in jumping and cutting sports. The reason for this is that the neuromuscular connection in the joint needs to re-grow for smooth coordination and timing to return. This connection takes two years to completion. The athlete who returns after 4-6 months is literally playing mind over matter, and usually matter wins.
Returning to full competitive play first requires dedicated work on speed, quickness, change of direction, jumping and landing, responsiveness, balance and stability. All of this needs to happen under a watchful eye to help re-establish balance.
- Moving to right and left evenly, with equal pace and smooth form.
- Moving in all directions with safe and effective pivot and good mechanics.
- Moving in confident anticipation and responding effectively to opponents’ unpredictable challenges and changes of direction.
There’s a lot to the game which is well beyond the controlled mechanics performed in the physical therapy clinic during injury rehab. All of this needs to be re-learned and re-developed before the athlete is ready to take the competitive field and train full-contact.
De-conditioning requires re-conditioning.
De-conditioning happens during every lay-off as the body rests itself to recover fully. Unless you’re a professional athlete like Bryce Harper or Jayson Werth (or any number of Washington Nationals) with a full time training staff at your disposal, injury time off will take its toll on the whole body.
While rest is essential for repair during recovery, it can be detrimental to other body parts that are lazing along for the ride. This is the case especially when a long-term injury takes an athlete off the field. After an ACL injury, not only the knee but the whole leg, hip and torso unit need to re-engage and be brought back up to speed.
The hip connected to that leg has lost strength, mobility and responsiveness. The core muscles on that side have compensated to maintain balance. Muscles around the knee may be weak, especially (ironically) on the non-injured side after dedicated therapy focused on the surgical side. Foot and ankle support probably has also declined.
All of this – foot, ankle, knee, hip, torso, posture, functional movement – needs to be assessed and retrained to restore balance and help an athlete return to play. Return to anything that feels even remotely like “old form” takes time, patience, discipline and a trained eye to help them recover.
Filling the gap between “medically cleared” and “full contact.”
While the athlete is in formal rehab, he or she will be gradually adding safe challenge to each movement, engaging the previously injured and de-conditioned body parts on the way to allowing eventually to be “cleared” by the physician. However, while the physical therapist measures strength and range to document the recovery process, these do not indicate full readiness for play.
De-conditioning in the whole body plus speed, coordination and dynamic balance demand attention before the player is ready to return to play. Sluggish movement and responsiveness – *which are natural outcomes after a long injury lay-off* – make the return to play uncomfortable and maybe even frightening for the athlete. They know things don’t “feel” right, but they need help identifying what is still sub-par and focused practice on those mechanics.
This is the know-how behind Fit2Finish Gap Care Training, designed specifically to fill the gap for the athlete in the time between medical clearance for sport and ready to return to play. Fit2finish specializes in gap training with athletes recovering from knee injuries and ACL surgery. We coordinate with the player’s physical therapist and doctor to facilitate a smooth transition from therapy and a strong progression back to sport.
We have a common goal: keeping athletes in the game. When they have suffered an injury, we want to get them back into play as soon as possible, but we also want them to stay there. Frankly, I don’t want to see them again — unless it’s to show me their championship medal, their scholarship offer or the big smile that means that their next opportunity is beyond their wildest dreams.