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When Is It Safe To Return To Play?

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How do I know when my child is safe to return to sport after injury?

It is becoming more and more common for kids today to specialize in a single sport.  This means that kids are playing one sport year-round, often for several hours per week.  They are undergoing significant and repeated stresses on their growing bodies.  This increase in sport specialization may be one reason we are seeing a rise in youth sport injuries in our clinic. 

Often times youth sport injuries can be classified as either traumatic injuries or overuse injuries.  A traumatic injury occurs suddenly such as a ligament sprain, muscle strain, fracture, or brain injury as a result of a fall or collision.  An overuse injury occurs over time and is a result of repetitive micro trauma such as a tendonitis or stress fracture.  Overuse injuries may occur from doing too much of one type of physical activity without rest or from poor technique with repetitive activities like overhand throwing, swinging a golf club, or running.

Physical therapy treatments vary depending on the injury and the child’s symptoms.  It is important to treat not only the injury and symptoms, but also the cause of the injury.  The symptoms may include pain, swelling, limited range of motion, and weakness.  Understanding the cause of the injury may take some time.  For example, it is inappropriate to assess an athlete’s running form if the patient is still limping.  Likewise, if a baseball/softball pitcher has pain and/or limited motion, it would not be beneficial to analyze his/her form with throwing, as it may be compensated.  Therefore, it is necessary to treat all stages of the injury. 

As patients are progressing and resuming normal daily activities without pain or limitation, physical therapy interventions are tailored to fit the individual’s sport-specific demands.  It is important to understand the athlete’s level of activity (from recreational to elite) and specific demands of the physical activity (running, cutting, jumping, tackling). At this point, focus is on the athlete’s neuromuscular control, balance, coordination, and postural stability.  Retraining the athlete’s awareness, form, and mechanics is necessary to prevent recurrence of injury.  Therapeutic activity progressions should be functional for each specific sport.  This may mean adding speed and plyometric challenges, unlevel surfaces, unexpected perturbations, and sequential movements that challenge the athlete’s core, upper, and lower body simultaneously. 

As these athletes tolerate returning to sport-specific drills and training, with proper form, it is likely time for return to light practice (non-contact).  The next step is full-contact practice with full equipment and game/competition environment.  It should challenge the endurance, power, speed, and effort of the athlete as a game situation would.  Obviously, the next step is full return to play.  It is important that the athlete knows what signs/symptoms to look for when returning to his/her sport, so as to avoid re-injury.  Patient education is necessary at each stage of rehabilitation to give the athlete expectations throughout his/her treatment.  In addition, proper education helps to train and encourage the patient’s body awareness.

Lastly, I believe that the most optimal and efficient outcome is facilitated by open communication between the physical therapist, athlete, parents, caregiver, coach, athletic trainer, and physician 

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