Story by Ronald W. Lindsey, MD, of UTMB South Shore Harbour Clinic at 3023 Marina Bay Drive in League City, 281-334-0620
Sports-related injuries occur frequently. Modern medicine has become quite adept in accurately diagnosing and effectively treating these injuries. However, determining when an injured athlete can safely return to play (RTP) can be exceptionally difficult.
If an athlete is prematurely cleared to resume competition at a pre-injury level, the risk for re-injury is quite high. Often the re-injury can be even more debilitating than the initial setback. On the other hand, an inordinate delay in RTP may not only exacerbate the athlete’s general de-conditioning but even hamper full recovery from the injury. Moreover, a multitude of other factors (social, emotional, political, ethical, etc.) may have a profound effect on the RTP decision-making process. Although these other influences are duly recognized, an athlete’s overall health and safety (along with the health and safety of other competitors) should be considered paramount in any decision regarding RTP.
The principal motivation should always be the same: to restore the normal function that has been lost owing to the mishap. This objective should apply to the highly acclaimed professional athlete as well as to the enthusiastic weekend warrior. To achieve this, it is essential that every aspect of the RTP process include the active participation of a healthcare professional (physician, physical therapist, certified athletic trainer, etc.). The athlete not only must be willing to comply strictly with their jointly developed recovery program, but also must have a clear appreciation of the functional targets that must be achieved prior to getting back into sports.
Although some strategies currently exist to assist with RTP decision making, no specific guidelines have been widely accepted as the standard. It is doubtful that a routine method for addressing recovery from all athletic injuries is even feasible. Return to organized athletic play often falls under the jurisdiction of schools, organizations, communities, or local laws and their policies will likely differ. Furthermore, different injuries (by individual or by sport) will require drastically different considerations; thereby, each case warrants individual deliberation.
There are, nonetheless, several strong recommendations that should assist in properly directing the RTP process:
•Maintain general conditioning to the extent permitted by the injury.
•Seek to return fully to the activities of normal daily life, prior to seeking to compete.
•Full clearance to play must include unrestricted practice activities.
•Consider the nature and/or extent of any special treatments, equipment, medication, or athletic activity modification that would be required to resume competition.
•Professional healthcare provider participation is fundamental at every stage of the process (even for seemingly minor injuries).
•Major injuries (e.g., concussions, spine injuries, or adverse cardiopulmonary events) merit a second or independent medical opinion from a healthcare provider who is not typically a part of the injured athlete’s usual medical management team.
Additional information on this topic can be obtained from the websites of the following organizations: the American Academy of Orthopaedic Surgeons (AAOS), the American Orthopaedic Society for Sports Medicine (AOSSM), the American College of Sports Medicine (ACSM) and the American Medical Society for Sports Medicine (AMSSM).
