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Option 3: Sports Medicine

How is injury rehabilitation managed?
Return to play

Key Messages

When the decision to return to play is being made, the main priority should be the athlete's welfare and safety. Medical staff, coaches and the player should all be consulted in the decision-making process.
Physical indicators of readiness to return to play include being pain free and experiencing a return of the mobility to the injured area.
Player progress can be monitored via physical testing that is sport specific and by comparing results pre and post injury.
A player needs to be psychologically ready to return to play.
Athletes who sustain an injury may need to alter warm-up procedures to reduce the risk of re-injury.
Relevant return-to-play policies and procedures need to be examined. They vary from sport to sport and by nature and severity of injury sustained.
Players should not return to play until their injury is fully healed, as further injury will make the healing process more difficult and protracted.
Many things should be considered before returning to play following injury. Being pain free, having full mobility, being able to perform sport specific movement patterns and being psychologically ready are the most important factors.
Ethical considerations such as a pressure to participate and use of painkillers need to be thoroughly considered by athletes as recurrent damage to injured areas can cause long-term problems.

Returning to sport or physical activity before an injury is healed is likely to cause greater damage.The indicators that provide suitability of the athlete to return to play are governed by several factors. Degree of mobility and pain free movement are both important aspects for an athlete. Appropriate warm-up procedures, taping, monitoring progress and progressive involvement back into the game are used as keys to the readiness of return to play in particular sports.

Indicators of readiness for return to play (pain free, degree of mobility)

The degree of mobility around the injured area needs to be complete and relatively pain free to allow the greatest chance of playing to full potential. The athlete should be able to perform movements and skills similar to an event or game situation.

Monitoring progress (pre-test and post-test)

Returning an athlete to play may depend on them meeting a certain criteria or fitness test to determine readiness. Having both pre-test and post-test results and monitoring the progress for fitness allows the coach or medical practitioner to make an educated decision on the player's present fitness without risking further injury.

Psychological readiness

After an injury, an athlete may feel quite anxious about returning to play. Even if the athlete is physically recovered from an injury, they may not be psychologically ready to return to elite competition. In this case, a coach may play them in a lower division until they are back to their best.

Specific warm -up and procedures

During a warm-up, there may need to be more focus on exercises that work the recovered area and prepare the area for the demands it may encounter in the game/event.

Return to play policies and procedures

Individual sports will have their own specific return to play policies and procedures. The athlete's wellbeing should be central to any return to play policy. Contact sports usually have a policy about returning to play after a head injury.

Ethical considerations, eg pressure to participate, use of pain killers

Along with the physical and psychological recovery from injury, an athlete will often feel other pressures to return to play, e.g. a fear of letting the team down if they don't participate, pressure from sponsors and coaches in deciding events/games and financial pressures. If an athlete returns to play too early after an injury, they risk long term injury which can be season or career threatening. Using painkillers also increases the likelihood of further damage to an existing injury due to the painkiller masking the body's natural response.

Student activity
Research and evaluate skill and physical tests that could be used to indicate readiness for a return to play for a selected injury and sport.

Further understanding of return to play can be found on the following links:

Reflect on how return to play after injury rehabilitation is managed, e.g.

Critically examine policies and procedures that regulate the timing of return to play, considering questions such as:
Why aren't such policies applied to all sports?
Who should have ultimate responsibility for deciding if an athlete should return to competition?
Should athletes be allowed to use painkillers in order to compete when injured?
Analyse the impact of an injury on an athlete who returns to play before their injury is healed.

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