Having an injury that keeps you off the field can be the most frustrating experience. What can be worse, is not knowing when you’ll be ready to return or wondering why you haven’t been cleared. When is the right time? Physiotherapist, Andrew Alexander, explains how we at Physio Connex, Tuggerah, go about making return to sport decisions.
The first thing to keep in mind is that every injury is different and affects each athlete in a different way, so the decision-making on this can be challenging. To help get your head around what goes on in your physio’s head, you need to know a little bit about how the body recovers from injury.
- Acute Phase
Goal: prevent further injury
This is the time directly after your injury that can last 72 hrs to one week. There’s bleeding, as your body sends cells and chemicals to generate inflammation and begin the repair process. This is the painful time when you are usually the most restricted. Physio at this point will be aimed at protecting the area from further injury and providing exercises to help you start the next phase as soon as possible.
- Proliferation phase
Goal: restore range of motion and commence light strengthening
After the bleeding has stopped and the inflammation is settling, the body lays down the tissue required to repair the damaged area. The pain is normally less and can feel like the injury is nearly better, BUT IT IS NOT. This can occur over weeks after the injury and it normally isn’t appropriate to return to play in this phase. This is the stage where some players can go wrong – pain starts reducing so you decide to return to sport, but you haven’t waited for the tissue to repair. Physio will be aimed at achieving full range of motion, begin strengthening, and hands-on treatment to ease the pain.
- Reorganisation phase:
Goal: strengthening and preparation for return to sport
The tissue has been laid down over the injured region and normally the pain has stopped by now. The body’s job is to reorganise the tissue into the same structure as the surrounding muscle/ligament/tendon or bone. Without this phase we are left with poorly organised and WEAK tissue – more likely to re-injure in the future!
Strengthening is key here and placing the tissue under the same conditions it will need for your chosen sport. This is where training resumes at an appropriate level (eg running at 60% pace without contact). Returning to play here can happen but with caution, as the tissue has not reached full strength and is likely to restrain/tear/break.
- Sport-Specific Training
Goal: you are prepared to return to sport, but let’s get ready to perform!
After the tissue has been laid down, organised and strengthened you should be feeling ready to return. So, the final hurdle to clear is getting your whole body fit and able to perform all required tasks. Often your skills, endurance and cardio fitness can drop while you are in rehab and this is important to keep in mind when returning back to play. The importance of preparing your body for all game situations BEFORE RETURNING cannot be understated. Drills, passing, tackle technique, sprinting, change of direction, acceleration/deceleration, kicking accuracy are all boxes that need to be ticked prior to play.
As a Physiotherapist, it is our job to plan with your coaches and estimate how long this process will take. The above principles are the basis to what is going through our heads and what helps us to make a decision regarding return to play. So, when your physio says “let’s aim for 4 weeks, or 6 weeks” they aren’t trying to keep you off the field unnecessarily, they are simply trying to make sure you stay on it once you get back.
Written by Andrew Alexander