Everything you want to know about preparing your athletes for return to sport from a sports clinical specialist (part 1 of 2)

Each year numerous athletes get “re-injured”.  What are you doing for your return to sport process?!
 
Return to sport testing is always an interesting topic discussed within sports medicine.  It is an ever-growing subsection of sports physical therapy.  While we wait for research to catch up to validate and create reliable tests, what else can we do to put our athletic patients into the best possible situation for a healthy return? 
 
The most important thing with the return to sport process is understanding what components are necessary to consider.  For many physical therapists this means ROM, pain, strength, and a few validated tests in the research (think hop tests).  Yet this is not nearly enough to consider.  In fact, it’s not even close.  Let me explain some of the things I look at when treating athletes.
 
Basic Measurements:

• “Normal” ROM of both affected joints and influencing joints
  • Ex: Post op ACL knee extension should be relative to contralateral side
  • Ex: “Normal” is different considering athletes sport and position.  A baseball pitcher will always have more ER than IR and differences side to side.  Look at total ROM side to side in these athletes. 
• Adequate strength levels (what is considered adequate?)
  • Do you use MMT’s?
  • Do you use a hand held dynamometer? (Possibly more objective)
  • What position are you testing them in?
• No swelling
• Appropriate healing time
  • Remember your tissue healing guidelines
  • Be aware of ACL reconstruction healing timeframes
  • Always consider any additional con-current injuries (meniscus, cartilage, etc)
• No pain (Visual Analog Scale?)
• No feeling of instability
• MD clearance (Important!)

 
Task Analysis & Sport Biomechanics:

• Have you trained your athlete for the correct energy system demands of their respective sport?
• Technical Assessment (not our realm/field)
  • Ex: Baseball pitching “style”.  Be aware and observant but respect the pitching coaches. They are pitching coaches and you are the physical therapist.  Work together, stay in your lane. 
• Injury “prevention”
  • Home Program
  • Dynamic warmups pre competition or practice
• Sport Biomechanical Considerations

 
Psychological

• What is the athlete’s mental state?  What other personal factors (life, family, etc) may be playing a role?
  • May use an outcome measure

 
Fatigue

• One thing that is constant in return to sport is that fatigue can play a role in potential altered mechanics.   While it is tough to measure fatigue here are two ways I try to measure fatigue.
  • Lower Extremity:
    • Single Leg Squats for 1 minute (observe mechanics)
    • Single Leg Squats for 1 minute with perturbation (observe mechanics & control)

Part 2 will cover specifics on loaded vs unloaded movements, sports specific tests, and return to sport tests! Stay Tuned!

Dr. Brian Schwabe, PT, DPT, SCS, COMT, CSCS
Board Certified Sports Physical Therapist
​IG: @brianschwabedpt