Return To Play: Does PT Discharge = Sport Ready?
“Only 55% of athletes post ACL surgery return to competitive sport” (1)
An ACL tear is one of many injuries that often fall under the “career-ending” category. Others include rotator cuff, meniscus, Tommy John’s, MCL, hamstring tears, and many more. Statistically, the odds of returning to competitive sport participation at the same level is NOT in favor of the injured athlete. Too many times we hear the story “I was going to play in college, but I got hurt in high school.” What makes return to sport nearly impossible for these types of injuries? ACL surgeries and similar injuries have extended rehab times from 9 months to over a year. This creates an overwhelming demand for time, resources, and finances.
Team EFFORt
Surgeon
Physical Therapist
Strength & Conditioning Coach
All three providers want a successful outcome for the patient, but each provider uses different indicators of success. Understanding these indicators of success will help in understanding why all three are necessary for return to play.
Surgical graft integrity and tissue healing are key indicators for a surgeon. To avoid a surgical failure, the surgeon will provide the physical therapist with post-operative restrictions and a post-op protocol of do’s and don’ts. The physical therapist will use range of motion, strength, movement quality, and functional capacity as key indicators for success. Unfortunately, the strength & conditioning coach is often not available or left out of the rehab process in anyone not directly involved in collegiate or professional athletics. Herein lies the problem and lack of success with regard to full return to competitive sport.
Put ME in coach!
The patient goes through a good rehab protocol with physical therapy and is now cleared for activity with no restrictions. Great job team, we’re done! Unfortunately, not even close. Too often, the patient is discharged on the criteria discussed above. It’s been 5 months and the surgical graft is strong, the tissues have healed, range of motion is restored, it’s safe to do all activities, and the patient is “discharged to continue home exercise program independently,” but what about those leg muscles that are still half the size of the other leg…..
are you “actually” ready
This is the part that most patients miss. Either because they are unaware of the necessity or a lack of resources. This is not the patient’s fault. “The patient can perform all activities safely” - that’s all the insurance company needs to hear for them to stop covering the bill. When was the last time your physical therapist tested your max vertical jump height, clocked your 40yd dash, or tested your 1RM strength? If your PT is doing this, then you’re in the right place. If not, how do you know you’re ready to return to your sport? The physical demands of sport are far greater than that of every day life. There is a huge gap between being discharged from standard PT care and being ready to return to sport. This gap is too often not addressed. Re-injury rates are staggering for both the same side and the opposite limb.
Rehab to Performance pathway
A patient trying to return to sport activity needs to meet the following requirements:
Strength
Power
Acceleration/Deceleration
Agility
Coordination
Reactivity
Confidence
How do we know if an athlete is ready to participate in practice and compete in games if we don’t test it in a controlled setting?
We know a patient is ready to return to sport through objective testing and data collection. The list above are all key performance metrics. If the goal is to return to sport, invest the time and resources into a provider or clinic that is going to offer the full comprehensive plan of care.
Complete standard PT care at a traditional clinic. then, transition to a sport performance coach, or find a physical therapist that does both.
Without this final phase of the rehab process, the patient is at risk of either re-injury or low performance capacity. Many clinics are starting to invest in this final phase by either hiring sport performance coaches or PT’s who can provide this role. This is bridging the gap between rehab and performance, and it is vital to the success of patients undergoing the return to play process.
If you’ve had one of these types of injuries and are in need of the transition from rehab to performance, we specialize in the return to play process.
Schedule a physical therapy session with us today to get back to your sport ready to meet your sport specific and position specific demands.
References:
Ardern CL, Webster KE, Taylor NF, Feller JA. Return to sport following anterior cruciate ligament reconstruction surgery: a systematic review and meta-analysis of the state of play. Br J Sports Med. 2011 Jun;45(7):596-606.
Disclaimer: This SciSport blog post is a summary of an article printed in an academic research journal. The purpose of this blog post is to provide readers with academic and educational content in an easy-to-understand format. We take no credit for the material and knowledge presented, and we encourage readers to take a look at the original source provided in the References section
