When Can I Return To Play?
About the first thing a patient wants to hear when they come into Keilor Road Physio is when can they get back to doing what they love? At Keilor Road Physiotherapy, we consider the following things when we look at rehabilitation and returning to running, training, and then play:
1. The injury type
Bones, muscles, tendons and ligaments - all heal at different rates and all deal with the stresses of sport and life very differently. So, it makes sense that the different conditions that we see must be managed differently. Evidence show's muscle injuries - particularly hamstrings - and tendons can actually tolerate a little bit of soreness during rehab and during play without doing further damage. The evidence for bony pain isn't as favorable. It is important that injury type is considered in your rehab. Healing takes time and tissue healing timeframes need to be respected. We know the length of time it takes for a structure to heal and as such allows decisions to be made based on what we know the injured tissue is structurally capable of.
2. Your current capacity and the demands of the sport
When considering returning to activity, it is important to consider what demands the activity will place on your body, and your body's capacity in respect to these demands. For example: injuries to muscle can reduce the amount of power it can produce, as well as its ability to stretch, whereas joint injuries can cause decreased stability at that joint in response to stress, and a reduced tolerance to loading (such as running).
It is established that running at a jog-pace requires your Soleus muscle (one of two calf muscles) to produce up to 7.9 times body weight at each step, whereas running at a sprint demands your hamstring to be able to generate just short of 9 times body weight. Similarly, studies show that restrictions in ankle range of motion place increased demand on the hip and knee, as well as increasing the force transferred through the lower leg, potentially increasing the risk of other injuries occurring. As any mechanic or engineer would tell you, if demand exceeds capacity, you get structural damage and the same is true for the human body. Too much demand can lead to injury and or re-injury, and therefore, it is essential that we are only exposed to the demands that we can deal with. Your physiotherapist will use their expert knowledge of movement and their demands to make sure that you are ready for what's required.
We use your current capacity and function to guide our decision making - ensuring that you progress as quickly as you are able to, as well as being properly prepared for what that decision throws at you.
3. The movements of your sport
Sport is more than just muscle strength (even for weightlifters)! It is for the most part, a series of movements, and your ability to perform these determines how well you can compete. We run, jump, change direction, pivot, and throw - to name a few. Your return to playing well is dependent on how well you return to doing these. As such, restoring these movements forms the main focus in our rehab from day one, as well as being a key criteria in our decision making.
Training these doesn't have to be specifically practicing them either. Our skilled physiotherapists can breakdown each movement and incorporate them throughout your rehabilitation, allowing you to maintain or improve your ability to return to sport.
4. Other factors:
I have outlined the main specific physical factors that are considered in returning to sport specific functions and training, but there are certainly other things we consider too. These are sport specific and individualized to you and your injury.
Evidence shows that significant spikes in workload can increase the risk of musculoskeletal or physiological injury. Obviously, from the rehab table to the field is a significant jump, and thus, this needs to be considered and accounted for in the return to play decision making and progression. Evidence shows that there may be a potential sweet spot of increasing workload that avoids elevating the risk, without taking forever to get back on the pitch.
Similarly, for most sports, cardiovascular fitness is very important to your performance. It's shown time and time again that fitter individuals on the whole perform better than those with less fitness in AFL, soccer and many other sports. It can take as little as two weeks of detraining to see reductions in cardiovascular endurance, so it is incredibly important to keep on top of this during an enforced injury break. At Keilor Road Physiotherapy, we are more than conscious of this and can put in place plans to avoid losses in fitness while still protecting your injury.
While injuries are frustrating but common, what is even more frustrating is returning from an injury and having a recurrence. At Keilor Road Physiotherapy, we consider every possible factor in our decision making to ensure the risk of recurrence isn’t significant.
Keilor Road Physiotherapy prides itself on using the latest evidence based diagnostic and treatment techniques in our return to sport programs, that’s why we’re trusted by Geelong AFLW, Carlton AFLW, Essendon AFLW, Olympic and Commonwealth Games athletes, Hockey Australia and local sporting clubs throughout the North West of Melbourne.
Servicing Niddrie, Essendon, Airport West, Keilor & Melbourne’s Northern suburbs for over 40 years, you can book with one of our Sports Physiotherapists below or call 93794557 to speak to one of our admin superstars.
Related links
References
Tim W. Dorn, Anthony G. Schache, Marcus G. Pandy. Muscular strategy shift in human running: dependence of running speed on hip and ankle muscle performance. Journal of Experimental Biology 2012 215: 1944-1956; doi: 10.1242/jeb.064527
Järvinen, T. A., Järvinen, T. L., Kääriäinen, M., Kalimo, H., & Järvinen, M. (2005). Muscle injuries: biology and treatment. The American journal of sports medicine, 33(5), 745-764.
Mujika, I., & Padilla, S. (2000). Detraining: loss of training-induced physiological and performance adaptations. Part II. Sports Medicine, 30(3), 145-154.
Johnston, Richard J., Mark L. Watsford, Matthew J. Pine, Robert W. Spurrs, Aron Murphy, and Elizabeth C. Pruyn. "Movement demands and match performance in professional Australian football." International journal of sports medicine 33, no. 02 (2012): 89-93.
Hickey, J. T., Timmins, R. G., Maniar, N., Rio, E., Hickey, P. F., Pitcher, C. A., ... & Opar, D. A. (2020). Pain-Free versus Pain-Threshold rehabilitation following acute hamstring strain injury: a randomized controlled trial. journal of orthopaedic & sports physical therapy, 50(2), 91-103.
Gabbett, T. J. (2016). The training—injury prevention paradox: should athletes be training smarter and harder?. British journal of sports medicine, 50(5), 273-280.
Article by
Emily Irvine | Physiotherapist
Emily graduated with a Bachelor of Physiotherapy (Hons) from Monash university in 2020. She completed her thesis looking at the role of strengthening exercises on chronic neck pain.
Currently Emily holds a physiotherapist role with St Kilda Football Club AFLW, having worked with the club since 2019.