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Return to Play How to reintroduce the inj ured athlete to activity - PowerPoint PPT Presentation

Return to Play How to reintroduce the inj ured athlete to activity What is RTP? PROCES S of integrating an athlete back into participation Medical clearance of an athlete for full participation in sport without restriction


  1. Return to Play How to reintroduce the inj ured athlete to activity

  2. What is RTP?  PROCES S of integrating an athlete back into participation  “ Medical clearance of an athlete for full participation in sport without restriction (strength and conditioning, practice and competition)” Creighton, 2010  S afety

  3. Athlete centered care  What is best for the athlete needs to be at the center of the discussion  Other health/ physical risks  Psychological wellbeing  Long term wellness  May not be the same as what is best for the team  May not be the same decision you would make for you

  4. Decision making process  Who is involved vs who makes final call  Conflict of interest?  Risk – Economics – S ocial – Legal  Have a framework in place  Outlined progressions & check ins  How to make final decision

  5. Health Team’s Role  Communicate with coach and athlete  Cleary outline the proposed structure of RTP  Milestones  Pre-participation requirements  Explain timelines are variable  Provide best practice care  Follow through

  6. Coaching S taff Roles  Technical and tactical  Facilitate athlete’s needs through RTP process  Two-way communication with health team  Expectations of athlete

  7. Athlete’s Role  Commit to RTP process  Honest communication with health team and coach  Openness regarding state of mind, concerns  S eek out support

  8. Maintenance  Cardiovascular fitness  S trength  Flexibility

  9. Monitoring  RPE (Rate of Perceived Exertion)  Mood questionnaires  S leep habits  Diet

  10. Case S tudy Overview  Athlete: 24 y/ o Male College Basketball Guard  MOI: Opponent drove elbow on to top of distal clavicle, causing inferior glide to clavicular end of acromioclavicular j oint  Diagnosis: S econd degree AC sprain  Initial management:  sling x 2 weeks followed by passive and active ROM and isometrics  Isolated single plane strengthening as tolerated until full pain free range is attained

  11. 1. Functional Movements  Consider  Patterns  Body positions  Weight bearing  Implements

  12. Case S tudy 1. Functional Movements  Initial S trength Progressions  Anterior pressing with depth control; high reps  Cable PNF patterns  Weight bearing on stable/ unstable surfaces  Dynamic S trength Progressions  S ingle arm DB snatches  Dynamic landmine pressing  Medicine ball throws  Ballistic weight bearing  BOS U ‘ pops’  Plyometric/ Depth pushups

  13. 2. Individual S kills  Pain-free motions  Re-introduce locomotor skills as soon as pain free and limited risk  Coach involvement – technique

  14. Case S tudy 2. Individual S kills  Transition to on court work  Identify skills necessary for the athlete’s position  Progressions:  S tatic shooting controlling distance and repetitions  S tatic passing controlling direction and distance  Dynamic shooting  Reactive passing  Defensive position

  15. 3. Partial Practice  Frequency  Daily practice, every second practice  Intensity  % effort, style of drills  Time  Consecutive duration, total minutes  Type  Drills, systems, skills  Taping or bracing

  16. Case S tudy 3. Partial Practice  Protect with tape to aid in progression to more dynamic environment  Progressions:  Controlled defensive positioning/ Defence walk through drills  Active defense drills designated (player designated as non- contact)  Controlled offensive set piece drills  Live play offence (designated as non-contact)

  17. 4. Full Practice  Required amount of full unrestricted practice time can vary depending on the athletes performance  * Risk of inj ury may be increased in other areas  Development of intangibles of full participation

  18. Case S tudy 4. Full practice  Practice quality can challenge rehab progression  Worked with coaching staff to identify key components of practice that will allow athlete to compete at game pace  Ensure inj ured athlete and teammates are aware that identified drills must be treated at game pace and intensity  Justifying the duration of ‘ Full Practice’ vs ‘ Game’ phase to coach and athlete

  19. 5. Game  Frequency  Consecutive or alternating games  Intensity  Quality of game, pressure situations, score  Time  Playing minutes  How many, when in the game  Type  Position played, special teams roles

  20. Case S tudy 5. Game  Decision making process returning to a varsity schedule of Friday/ S aturday games  Identifying an opponent or specific weekend for first game experience  Player’s position, style of play, and influence on set plays will impact how athlete is integrated into game  Impose more strict restrictions for the first game  Performance assessment  Pending circumstances or restrictions, evaluate performance of athlete in-game, post game, and prior to the following game  Alter limitations or restrictions as indicated based upon how the athlete responds to the initial return to game play

  21. 6. Continued Monitoring  Risk of re-inj ury may still be present  Continued ability to improve performance  Wean or alter tape/ brace/ equipment  Communication with coach/ athlete  Ensure follow up appointments are booked in advance

  22. Case S tudy 6. Continued Monitoring  Athletes and coaches often perceive a return to game play as a return to “ 100% ”  Encourage athlete buy-in about returning to “ 110% ”  Only once a full return to pre-inj ury workload for all practices and consecutive games, with no post-activity soreness or restrictions, can the athlete be deemed to be ‘ full’  Maintenance treatment sessions

  23. Athlete Perceived Readiness  Athlete must have full confidence in their ability to return to the game  Mental recovery may progress at a different pace than physical recovery  Underlying psychological conditions  How to evaluate?

  24. S ocial factors affecting RTP  Athlete-Therapist (& Coach) interactions  Relationship and rapport  Delineation of roles  Clear expectations  S ocial support: Emotional, practical, informational  Health team  S ports team: Coaches, teammates  Family and Friends

  25. Conclusion  RTP is fluid  Rarely ever a text book process  Requires commitment of athlete, coach and health team

  26. References  Blanch, P . & Gabbet t, TJ. (2015) “ Has t he at hlete t rained enough t o ret urn t o play safely? The acut e:chronic workload rat io permit s clinicians t o quant ify a player’s risk of subsequent inj ury” Brit ish Journal of S port s Medicine  Creight on, DW. et al (2010). Ret urn t o Play in sport : A decision based model. Clinical Journal of S port s Medicine, 20 (5)  Glazer, D. (2009). Development and Preliminary Validation of t he Inj ury- Psychological Readiness t o Ret urn t o S port (I-PRRS ) S cale. Journal of At hlet ic Training 44 (2)  Podlog, L., Heil, J. & S chult e, S . (2014). Psychosocial fact ors in sport s inj ury rehabilitat ion and ret urn t o play. Physical Medicine & Rehabilit at ion Clinics of Nort h America 25  S hrier, I. (2015). S t rat egic assessment of risk and risk t olerance (S t ARRT) framework and ret urn-t o-play decision-making. Brit ish Journal of S port s Medicine, 49  S hrier, I. et al (2010). The sociology of ret urn-t o-play decision making: A clinical perspective. Clinical Journal of S port Medicine 20 (5)  Walker, N., That cher, J. & Lavallee, D. (2010) A preliminary development of t he Re- Inj ury Anxiet y Invent ory (RIAI). Physical Therapy in S port 11 (1),

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