Injuries in athletics are very common in young athletes and often occur as a result of poor return to play decisions. Mild injuries may not require any lost time in practices or games. Severe injuries can be season or career ending. The decision of when to return to sports/physical activity can be tricky at best. Pain is not always the best indicator. Many injuries feel better before they are completely healed leaving the body vulnerable to re-injury. Many re-injuries can be more devastating than the original one. If any injury does not allow you to complete the following criteria for return – You Are Not Ready Yet!
If you return to the field or court before your injury is properly healed, you can cause more damage and potentially cause permanent changes in the way your body functions. There are several key areas that are important to examine before returning to your sport, including range of motion, strength, and functional testing.
Range Of Motion
It is important that the injured area is able to be moved in all directions that the joint allows without pain. For example, the knee allows for bending and straightening. The hip, however allows for more motion. The hip bends and extends both forwards and sideways and rotates the leg in and out. Joint motion should be equal on both sides of the body. If motion is restricted by pain or weakness, returning to activity could cause further injury.
All the muscles in the injured area need to be functioning properly before returning to sport. Resisting each motion that the joint allows can give an estimate of how much force the muscles are able to produce. Just like range of motion, this should not cause pain and the strength of each movement should be roughly the same on both sides.
Functional testing is critical in deciding when to return to activity. Just because the muscles surrounding an injured area appear strong does not necessarily mean they are ready to handle the demands of sporting activities. For example, if you play basketball, you need to be able to jump up and land on one ankle without falling over. In lower extremity injuries, balance should be tested to make sure the joints can stabilize themselves in an environment similar to that of your particular activity.
A good progression for many sports involves the following:
- Straight ahead jogging 100 yards to 1 mile
- Straight ahead running 100 yards to 1 mile
- Straight ahead sprint (75%) 20-100 yards
- Straight ahead spring (100%) 20-100 yards
- Backwards running
- High knees running
- High skipping
- Balance on one leg for 1 minute
- Balance on one leg with eyes closed for 30 seconds
- Jumping on both feet 20 times
- Jumping on one foot 20 times
- Running in a zig-zag for 20-30 yards
- Sprinting in a zig-zag for 20-30 yards
If any of these activities cause pain you are slowing down the healing process and extending your recovery time. At this point you should stop and rest before advancing to the next level because you are not ready to go back to full activity.
Once running and jumping are able to be completed without pain, other sport-specific activities should be incorporated into functional testing. For example, soccer players should initially practice short passes and if that does not cause pain, move on to longer passes. If that goes well, they can try shooting on goal. It would not make sense for a soccer player to try to play if he was not able to shoot the ball without pain, even if he could run without any problems. You should be able to complete all activities that mimic the demands that you will encounter in your sport without any symptoms before returning to your activity.
Consult your primary care physician for more serious injuries that do not respond to basic first aid. As an added resource, the staff at Nationwide Children’s Hospital Sports Medicine is available to diagnose and treat sports-related injuries for youth or adolescent athletes. Services are now available in five locations. To make an appointment, call (614) 355-6000 or request an appointment online.