I recently went through four different return to sport cases with my patients this past month. Three were ACL and one was an internal impingement case. Each time I make decisions about return to sport I consider the patients characteristics. While the research tells us certain tests are good, they don't always apply to our patients. Digging deeper to make sure you take each case on an individual basis is more important.
Take an ACL patient that is very low tone for example. They are going to have a very difficult time gaining strength throughout their rehabilitation. Furthermore, imagine if they were a mechanical mess. Clearly this is an example of a patient who may need some extra work and a much longer recovery time. So how would I approach one these patients? First I would look at the time frame and their requirements for the sport. A patient who is low tone and an MMA fighter would be out for at least 9-10 months due to the extreme positions their sport requires. But a patient who is low tone and baseball player may be able to return sooner depending on his position and mechanics. Again, it's all patient dependent. Another thing I might look at for a low toned patient is how their strength is transferring to both mechanics and power. Often times I've seen these low toned athletes get strong but struggle with controlling that strength. Spending additional weeks and months on mechanics can make all the difference. Lastly, how is their psychological state? I recently had an athlete that did well with his return to sport testing but was not confident in returning to game action. Did I return them? No, I didn't because mentally they needed to feel confident. This is where referring out to a sports psychologist can be useful. Furthermore, my approach with that patient has changed to provide additional encouragement and show them how good they have performed in the clinic.
Returning athletes back to their sports can be difficult. We must take into account so many variables (fatigue, strength, pain, psychology, mechanics, biomechanics of sport, power, etc). Most importantly though we must individualize it and understand the characteristics each patient presents with.