The criteria to define a return to competition or play (RTP) are quiet confusing and challenging for the people who are involved in the process. The primary objective and responsibility of the entire coaching and support staff are cause no harm in an athlete returning to playing at the highest level of competition.
The process and guidelines in establishing a strong ecosystem in place are key for RTP. The system has to be foolproof depending on sports and skill set and other variables taken into consideration. Each sport will have a different process and protocols in place for their athletes in RTP. One has to adhere to them for successful implementation.
Return to play system
An athlete’s RTP system should involve the following
• Team physio
• Personal physio
• Sports medicine doctor
• Mental conditioning coach
• Strength and conditioning coach
The goals of rehabilitation can best be described by the following objectives. Only when each of these goals has been attained can an athlete return to competition.
• Control the inflammatory process
• Control pain
• Restore joint range
• Restore soft tissue functionality
• Improve muscle endurance
• Improve muscle strength
• Develop sports-specific movement and skill patterns
• Improve all components of fitness
• Individualised maintenance programmes
Rational headway is important to provide reliability in success and to minimise the potential for re-injury. Assuming that clinical success assures a safe athletic performance may be the reason certain injuries have high rates of re-injury. Although an athlete may be considered to be completely rehabilitated in a traditional clinical setting, no assurance can be given for the restoration to expected levels of sports performance. Bridging the gap is the vital cog between clinical evaluation and RTP.
Medical personnel attached to the team or individual athlete must provide guidance on activity suitability during each phase of rehabilitation following the logical progression of the above objectives. One must also understand the psychological make-up of the athlete.
While many athletes require reassurance, the majority require a strong hand to thwart a premature return and exposure to injury.
The most common mistakes
1. Rehabilitation is often focused on a single muscle group. After evaluation of the athlete to find out which muscles are particularly weak, all muscles of the limb need to be exercised, concentrating on those that are weaker. However, the limitations imposed by the injury or surgery should be taken into account.
2. Rehabilitation may be neglected until the injured area reaches a similar level of pain or size as the uninjured side.
3. Exercises for developing proprioception are neglected and not given due significance in avoidance and return from injury.
4. Postural deficiencies, anatomical malalignment and biomechanical imbalances are commonly ignored when designing the rehabilitation programme.
5. Specific sports skills and the SAID (Specific Adaptation to Imposed Demands) principle are often not incorporated into the programme. Exercises should be adapted to the specific needs of the athlete’s particular position in a sport and highly specialised fitness protocols. This is a most critical aspect of RTP.
6. The progression of exercises must be tailormade not only according to the nature of the injury, but also to the type of surgery, if conducted, and the specific nature of the sport.
The development of these skill patterns prior to RTP will serve as a guideline to give the athlete and coach abundant prospects to understand the athlete’s new limitations, if any, in his or her skill set and fitness, as well as to mentally prepare the athlete for a return to full competition.
Sample progression in fitness activity
Step 1: Back to regular activity
An athlete is back to his or her regular activities (such as school or college).
Step 2: Very light aerobic activity
Start with light aerobic exercises to increase the heart rate. This means 5-10 minutes on an exercise bike or walking or light jogging.
Step 3: Moderate physical activity
Continue with activities to increase the athlete’s target heart rate. This includes moderate jogging, brief running, moderate-intensity stationary biking and moderate-intensity weightlifting.
Step 4: Heavy, non-contact activity
Progress to heavy, non-contact physical activities such as sprinting, running, high-intensity stationary biking, weightlifting and non-contact sport-specific drills (in all three planes of movement).
Step 5: Practice and full-contact sessions
An athlete may return to practice and full-contact sessions in a controlled environment.
Step 6: Competition phase
A fit athlete may return to competition.
The above progression will vary according to the nature of the injury, the sport played, skill sets, the place of injury and other variables. And, finally, each athlete’s RTP will vary. One format may not suit all.
Finally, progression is key to success in RTP
1) No activity, complete rest, recovery phase
2) Light aerobic exercises, target heart rate 70 percent less, heart rate increment phase
3) Sports-specific exercises, base drills, movement phase
4) Non-contact training process, complex training phase with all range of movement for skills in progression, coordination and cognitive phase
5) Full-contact training, post-medical clearance, contact phase can be resumed, functional skills through varied fields and fitness, physiological and psychological increment phase through support staff
6) Return to play with full efficiency.
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