Saturday, February 23, 2013

Getting Back on the Horse-Returning From Sport Injury

When we get hurt on the field of play or in the game of life there are several strategies (icing, massage, muscle activation, nutrition) we can use that help the body recover. [1] [2] But how do you know when it’s time to “get back on the horse” and return to action, is it simply when the pain goes away?

Keep in my mind that I am referring to soft tissue injuries that are mild in nature.  Addressing the protocol of return from a more traumatic injury such as a surgery or broken bone is beyond the scope of this article.

In professional sports and even most college and high school athletic programs an athlete has to be cleared by a trainer or coach before they are deemed suitable for return to play.   An athlete will take part in some type of agility test to determine if the are favoring the injured area.  The trainer/coach will carefully watch for subtle compensations that the athlete may be using to avoid stressing the previously injured area.   If the athlete is not able to move the way they did pre-injury they most likely won’t and should not be cleared to play.

If an athlete lacks the confidence to run aggressively and then stop quickly to make a change in direction it may be an indication that the injured area is not strong enough yet or the athlete may be fearful of re-injury.  This “mental” block can be quite a substantial one to overcome particularly for younger athletes with a first time injury.  In their attempt to avoid pain they may start to develop poor movement habits that could lead to a more serious injury while also hindering their long-term athletic development.  

When an athlete doesn’t play reflexively and is overly cautious they tend to move in a very choppy almost robotic manner.  This alters their body awareness and balance and could leave them vulnerable to a “big” hit because they lack that sixth sense to avoid collisions.  That aspect is often overlooked but body awareness and coordination may be an athlete’s best shield against on-field injury.

As is often the case the middle school aged children are often neglected in this regard.  Most middle schools do not have access to an athletic trainer that can test an athlete to ensure they are ready for return to play.  This is why it’s important that coaches and parents carefully monitor the way their young athletes move at all times, even when they are healthy?  You need to have some type of baseline to compare their return from injury status to.  Complicating the challenge for this age group is the pain, discomfort and disruption to body control that accompanies the adolescent growth spurt.

It should also be noted that even though an athlete passes a return to play test with flying colors the real test comes during game play.  Even a well designed agility test and the keen eye of a seasoned coach won’t be able to make up for the speed of the game.

Game action is the real test for the athlete returning from an injury.  Everything happens much faster in the game, it’s chaos and in this environment the athlete must be mentally sharp and confident that there body will be able to answer their every call instinctively without delay.

As parents and coaches we need to ensure that we keep a watchful eye on our young athletes at all times and just as importantly we must foster an environment that encourages non-judgmental communication.

We should be aware of the child who may seem timid and is not able to regain the “intensity” or “aggressiveness” they displayed before an injury that very likely left a painful memory.

Consider the following scenarios:

"It still hurts"
The first factor could quite simply be that the child still experiences pain as they are trying to play. If the young athlete feels empowered as a member of their own re-habilitation team, they will be more likely to let you know that "it still hurts". The fix here is simple; go back to the doctor or get a second opinion.

"I'm all done"
This factor is a little more difficult to rule out. In our efforts to promote our children through sport we sometimes forget that they are not little adults. Their likes and dislikes are fickle at best as they move through development and maturation. Today's favorite activity may be tomorrow's memory. Your child/athlete may be trying to let you know that they have simply lost interest in this sport and don't know how to tell you for fear that they will let you down.

As leaders of young athletes we need to create an environment where they feel like they can speak up on their behalf and be open about what they are feeling. Coaches and parents need to affirm the child’s feelings by letting them know that they are rational and normal. Then we need to guide them along with a return to play strategy (progressive goal setting) that honors each child’s unique situation understanding that sometimes the emotional and mental healing requires more time than the physical healing.


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