Return to Sport part 2

Now are they ready?

Time has passed, rest has been given and things are feeling better, but how are we sure the athlete is ready to go? Honestly we aren’t, at least not with 100% certainty. However, we can work through a specific recovery framework that will allow for the best possible outcome to be achieved. Moving through these various training elements will be a very individualized process and should not be skipped because “things are feeling good.” Use the tissue healing times as a general guideline but also take into consideration form and function. How well does the athlete move during a given skill or task? Do they demonstrating adequate joint mobility and stability? What are their endurance, strength and power levels like? Once some of those questions have been answered it is time to move into skill training and sport specific drills, which will bring them to the threshold of returning to sport.

Corrective and therapeutic exercise

The initial phase of the recovery process typically starts with corrective and therapeutic exercise. This can be initiated moments after an injury has occurred. Once it is determined that the area is stable, not getting worse or in need of secondary medical treatment, we can start to work on movements and techniques that help to keep the body for further injury but facilitate recovery. Simple things like compression, elevation and gentle pain-free movements can help with swelling and keeping the nutritional flow moving in and around the injured tissue. Strengthening and mobility work can be implemented to address near by areas that may be affecting the recovery rate or causing part of the problem such as working on hip and core strengthening for an ankle injury.

Chiropractor massaging a woman's knee

Stability and Mobility

As healing continues training for stability and mobility becomes a priority. It would make sense that both would need to be addressed simultaneously as working through specific exercises can improve mobility but yet we haven’t done anything to retrain our bodies on how to manage this new found range or stabilize the joint through the range. Mobility also references the tissue in and around the area that has been injured. Scarring and other disorganized tissue can drastically impact movement and recovery and can be addressed with soft tissue mobilization like stretching, massage, using a foam roller or a lacrosse ball. Take note of healing times though, you wouldn’t want to start mobilizing or stretching tissue that is in an active healing process which can potentially prolong healing as the stretching may be disrupting the tissue growth. It is never to late or to early to look at core stability, as this is a vital element for proper movement. Remember we need proximal stability to have proper distal mobility.

Endurance, strength and power

Research has shown us that once an injury occurs we see a decrease in muscle activity and atrophy in a given area. Moving through the recovery process will require time focused on endurance training, which will segue into strength and power development. These concepts can be both general and specific regarding the systems being trained. You can train a recovering sprained ankle for endurance and strength with single leg squats but also put in some time on the bike or the pool to work on general endurance and conditioning. As the necessary strength, stability and control is restored power will be one of the final areas to be addressed. Along with power should be sport specific drills and skill development. Almost every event or sport that we do is scalable so we can take advantage of working certain tasks from part to whole movements or reducing the load and demand as we work our way back into that task. Here is where we make our greatest strides towards understanding where we are in terms of returning to sport. If we progressively scale our loads and training demands without any significant issues, demonstrate proper movement patterns with solid motor control and have given the body adequate time to recover, our confidence in returning should be high. Remember mobility ensures movement competency but training ensures movement capacity!

The concept of power and determination of a man lifting a weight

It’s really that simple

Tongue in cheek comment to say the least. It’s fair to say that some people heal faster then others, they are “genetic freaks”, and should be considered the outliers on an average recovery bell curve. But even with genetic superstardom there are multiple variables that we can use daily to recover better, train smarter and get our athletes back out on the field faster. Things like sleep, high quality nutrition and general health can all influence healing rates. It goes without saying but the road to recovery can be an intimidating one, so getting in touch with a qualified clinician or coach can make the process less daunting.  But ultimately it is up to how the athlete feels and how they are responding to treatment and progressive return to sport. Confidence needs to be there as well, otherwise the mental blocks that can develop prior to returning can be just as limiting as any physical one. So train hard, train smart and be respectful of what the body is saying, it’s the only one we’ve got!

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