Safe Return to Sports & Activity

Injury is unplanned and never welcome. However, once an athlete is injured, part of the treatment plan involves estimation on the anticipated time out of action and return to play. These principles apply to athletes at all levels of competition and even to the everyday “active” person recovering from an ailment.

These criteria represent general guidelines and are consistent with those established by The American Orthopedic Society for Sports Medicine


Evaluation & Treatment

Treatment is a complex undertaking and involves several parties all of whom need to be informed and in agreement. Following the diagnosis and development of a treatment plan for an acute injury, regardless of body part or mechanism of injury, control of swelling, pain, stiffness and weakness is paramount. This is effectively done through RICE (Rest, Ice, Compression, Elevation)

Rest- either a defined period or a brief (symptom driven) period of protection is helpful to allow injured tissues to heal and reduces further tissue injury/bleeding/swelling. This may involve crutches and/or a knee brace for knee injury or sling or splint for upper extremity injury.

Ice – regardless of the location or severity of injury, ice directly to the site or area is best for the first 48-72 hours. Ice should be applied 20 minutes on and 20 minutes off the site if injury. It should be applied with a light covering between the skin and the ice. Ice should never be applied directly to the skin or for prolonged periods of time. This can cause severe frostbite burns. There is no single regimen for applying ice and opinions will vary. Any regimen is better than none at all. Heat is never OK for acute injury.

Compression – all tissue injury will result in soft tissue swelling. Sometimes this will be severe and sometimes minor. Following injury, a significant amount of rehabilitation time is usually spent undoing swelling, stiffness and weakness. Therefore, it makes sense to make every effort to reduce this from the beginning. The positive pressure of compression (ace wraps, ankle splints, etc.) help.

Elevation – this applies to injury at the ends of limbs more so than the parts closer to the trunk and torso. Elevate extremities as appropriate.

To this regimen can be added short courses of anti-inflammatory medication. Studies have shown that immediate use of these medicines for a limited amount of time such as 5-7 days may reduce the inflammation that injury may cause. Taking these medications is potentially harmful if there history of allergy to aspirin or similar medicines, bleeding ulcers, gastrointestinal problems, easy bruising or bleeding tendencies. Patients taking blood thinners should not take these medicines. Even some herbal supplements and vitamins may increase your risk of bleeding from these medicines. Pediatric patients should consult their physicians. 600-800 mg of ibuprofen (Advil or Motrin – these are all the same) 2- 3 times a day with meals for 5-7 days is the recommended dose for adults with no medical issues. Aleve 1-2 pills 2 times a day can be just as effective, if preferred.

After the acute or initial phase is over, the transition to heat is subject to opinion but may begin after about 5 days. Heat promotes soft tissue flexibility and improves range of motion of the affected extremity. Once the pain and swelling is controlled and range of motion is functional, muscle strengthening can begin. Rehabilitative exercises rely on lower weights and more repetitions. The concept is quite different from a workout using more weight and fewer reps.

The next phase of recovery begins when range is normal or almost normal as determined by pre-injury motion or compared with the other side. Strength should be improving and almost normal. There should be minimal or no swelling or pain. When this point is reached, then attention is turned to general conditioning. In order to return to sports rehabilitation of the musculoskeletal and cardiovascular systems are needed. This can be accomplished through a variety of means including swimming, running, indoor or outdoor biking, elliptical trainers, and treadmill or outdoor walking or running.

The last phase of recovery is sport specific skills acquisition and the power activities that will prepare for the safe return to sports. The type of agility drills will clearly depend upon the sport. For lower extremity injuries drills include sprints, cuts, crossover drills, figure of eights, and jumps. For upper extremity injuries drills include light throwing with progression as tolerated, the use a of a racket or swimming. The speed and intensity of play will increase with time until ready for return to sports. Many physical therapists perform return to sport or work evaluations and this is a good indicator prior to a full return.