Returning to Play

After a sports injury, it’s common for people – particularly young athletes – to want to return to play as fast as they can. But it’s important to make sure that the body has a chance to rest and fully recover after an injury, particularly a torn ACL, a break or severe sprain, or a traumatic brain injury (TBI) such as a concussion.

This blog will answer some common questions about returning to full athletic activity after a substantial injury.

What is the return to play protocol?

The return to play protocol is the process of rest then gradual return to full athletic activity recommended by the Center for Disease Control (CDC) after an athlete has experienced a concussion. There are six steps in the return to play process. 

At each step it’s important for the patient – and their parents or coaches if applicable – to watch out for any new or worsening concussion symptoms. If at any point symptoms get worse or new symptoms develop during the 6 steps of returning to play, you should pause and return to the previous step to give yourself time to recover. Don’t attempt the next step again until the symptom has been gone for at least a full 24 hours.

1. Returning to daily activities

Following the initial period of diagnosis and rest, the first step is to return to ordinary, physically non-strenuous day-to-day activities such as work or school. 

2. Light aerobic activities

The second step includes simple exercises designed to raise the heart rate such as walking, light jogging, or time on a stationary bike. These should be done for 5 to 10 minutes at a time, followed by rest.

3. Moderate activities

The next step is to continue with these activities for longer periods of time. At this point you can jog at a faster pace, do some running, or do some moderate intensity workouts on a stationary bike. You can also do some weight-lifting but stick to less time or less weight than your usual routine.

4. Heavy, non-contact activities

At this point you can return to all your regular non-contact activities: regular weight-lifting, running, sprinting, sports drills that don’t involve contact, etc.

5. Regular full contact practice

Step 5 is a full return to normal practice including full-contact activities such as tackling, wrestling, boxing, martial arts, etc. but in the controlled environment of practice.

6. Returning to athletic competition

The final step is returning to competition. Monitor your injury for any sign of returning symptoms, and continue warm up or any recommended physical therapy exercises in order to prevent recurring injury. 

How long should the return to play process take?

Like the recovery process itself, the amount of time it takes to return to full athletic competition will vary from one person to another. It may take a few weeks up to several months or more to complete the healing process depending on the severity of your injury. It’s important not to rush and to make sure that athletes and their coaches, families, and physicians are carefully monitoring their progress.

What are the psychological factors that can affect an athlete’s return to play?

• Fear of reinjury: This is one of the most common psychological factors that can prevent an athlete from returning to play. Athletes who are afraid of reinjury may be hesitant to put themselves in situations where they could get hurt again. This fear can be even more pronounced in athletes who have had multiple injuries.
• Loss of confidence: Athletes who are injured may lose confidence in their ability to return to their previous level of performance. This can be due to a number of factors, such as the severity of the injury, the amount of time it takes to recover, or the athlete’s own thoughts and beliefs about their ability.
• Depression: Depression is another psychological factor that can affect an athlete’s return to play. Athletes who are depressed may experience symptoms such as sadness, hopelessness, fatigue, and difficulty concentrating. These symptoms can make it difficult for athletes to participate in rehabilitation and return to their sport.
• Anxiety: Anxiety is another common psychological factor that can affect an athlete’s return to play. Athletes who are anxious may worry about getting hurt again, performing poorly, or not being able to meet the expectations of their coaches or teammates. This anxiety can make it difficult for athletes to focus and relax, which can impact their performance.
• Coping skills: Athletes who have effective coping skills are better able to manage the psychological challenges of injury and return to play. These skills include things like positive self-talk, relaxation techniques, and problem-solving.
• Social support: Social support from family, friends, coaches, and teammates can be an important factor in helping athletes return to play. This support can provide encouragement, motivation, and practical help.

Returning to play after an ACL tear

A torn ACL (anterior cruciate ligament) is another common injury that requires treatment and recovery time before returning to full athletic performance. One of the four major ligaments of the knee, the ACL is typically torn while suddenly stopping or changing direction during running or by a misplaced landing or collision during an athletic event.

How long does it take after ACL surgery to return to play?

ACL surgery is typically recommended for active adults with complete tears. Recovery time from ACL surgery typically lasts 6 to 9 months and involves physical therapy to slowly acclimate the patient to using their knee for normal activities again.

However, nonsurgical treatments are usually recommended for children and young adults, especially those with only partial tears, which are more common. In these cases treatment usually involves RICE (rest, ice, compression, and elevation), physical therapy, nonsteroidal anti-inflammatory medications, and possibly knee braces.

Returning to play will involve working with your physical therapist to make sure you have flexibility, strength, and a full range of motion in your knee before you begin any strenuous activities.

Signs and symptoms of a concussion

Concussions can result in many different possible symptoms, some of which aren’t immediately obvious and some of which don’t appear right away. If you’ve suffered an injury to the head, it’s better to see a doctor just to be safe.

Some common immediate symptoms of a concussion include:

• Headache
• Blurred vision
• Nausea
• Ringing in the ears
• Fatigue or unusual drowsiness
• Vomiting

Some symptoms that develop over time include:

• Difficulty concentrating
• Increased irritability
• Trouble sleeping
• Increased sensitivity to light and noise

How long does it take to recover from a concussion?

Full recovery from a concussion varies significantly depending on the person and the extent of the injury. On average, recovery from a concussion typically takes about 1 to 2 weeks, but some mild symptoms can last for weeks or months. If you’re still experiencing symptoms after 2 weeks, you should schedule another doctor’s appointment to check on your progress.

What are the risks of returning to play too soon?

With any sports injury, returning to play too quickly can aggravate your symptoms and slow your recovery time. Experiencing a second injury before the first one has fully healed can turn a relatively minor injury into something requiring more serious intervention such as surgery. While you may be eager to return to play, you should always wait until your symptoms have subsided or until you have medical approval. 

Return to play with help from Alexander Orthopaedics

The sports medicine team at Alexander Orthopaedic Associates has experience working with injured athletes to get them fully recovered and back on their feet. Our nurses, physicians, and physical therapists work with patients one-on-one to put together a customized treatment plan that addresses your particular needs. Contact us today to find out how we can help you return to peak performance.