Return to Play After Injury

by Dr. Victor M. Chang, PT, DPT, OMPT

Regular exercise is often suggested to maintain and optimize a healthy lifestyle and to reduce the risk of many diseases. The fitness industry is booming as more people are beginning to take an active role in their physical well-being. Participation in sports from young to old is rising, as it is not only just good to exercise, it is enjoyable, social, entertaining, and includes many other factors that contributes to overall quality of life. Unfortunately, injury is prone to happen - whether it is from a traumatic event or it just creeps up out of nowhere. Often times injury is associated with pain, which leads to a decrease in the ability to perform.

When can I return to playing?

One of the most common questions from athletes is, “when can I start playing again?” Often times you will hear the unsatisfying answer, “it depends.” Returning to play is dependent on many factors including:

- type and severity of injury

- acuteness or chronicity of injury

- level of irritability

- age

For many injuries, common sense will eventually bring the athlete back to a competitive level. During the acute stages of an injury, applying the commonly referred acronym RICE (Rest, Ice, Compression, Elevation) can do the trick. When it comes to playing again, the general rule of thumb to follow is: if it’s painful, don’t do it ... yet. The old saying, “no pain, no gain” does not apply here.

Why do I still have some pain and RICE is only providing temporary relief now?

This is when most people end up seeking professional help. The goal is to not just only identify the source of pain, but to also diagnose a movement dysfunction causing the pain. Often times, pain is still present not just because of the acute injury from when it first started. There is still pain because faulty movement patterns, that may have predisposed the injury, are present or the body has compensated into poor mechanics in trying to avoid painful movements.

What is a movement dysfunction and how does it lead to pain?

Preventing and correcting musculoskeletal pain is primarily dependent on restoring and maintaining precise movement of a specific joint or segment. The surrounding muscles and support structure must be in balance with proper coordination of muscle activation to ensure this precise movement. Any deviation from ideal movement leads to a cycle of microtrauma to involved tissues, and eventually progress to macrotrauma when the stresses are not accommodated for.

So how do I get better?

If RICE and general pain free stretching does not alleviate most of the pain over the first 2-3 weeks, then there is likely an underlying movement impairment or alignment imbalance that is inhibiting full recovery. A movement impairment diagnosis should be made with an explanation of how this impairment is leading to the pain experienced. Musculoskeletal alignment must be addressed, as imbalances will lead to poor muscle activation and essentially affecting movement. Not only is musculoskeletal alignment important, but also the re-education of proper movement with precise activation of the neuro-motor pathways is essential to prevent re-injury.

- The key is not what is painful but WHY is it painful?

- The goal is to establish WHY certain movements and/or positions are causing painful stresses to the body

Once the source and cause of pain is identified with its contributing factors, a treatment and training strategy is designed. Treatment and management usually consists of very specific and focused corrective exercises and education. Manual therapy, manipulative techniques, dry needling and other methods may be utilized to correct alignment and restore mobility in order to speed up recovery and alleviate pain; however, performance of corrective exercises is essential to ensure correct movement patterns are used in daily life and that alignment imbalances are minimal and insignificant. Manual adjustments and other passive methods may help to correct alignment, alleviate pain, and reset the body to initiate healing; however, these interventions tend to be temporary as long-term changes occur when the athlete is disciplined by actively re-educating the body with balanced movement and precise neuro-muscular control.

Returning to Play

When movement impairments are identified and addressed, often times an athlete is able to begin introducing sport specific exercises back into their training regimen. As sport specific exercises progress without pain, the athlete will begin to gradually return to a competitive level of play. The expectation is that the athlete is now aware of his or her tendencies and vulnerabilities towards previous movement faults and is able to correct them to not just only help prevent future injuries, but to perform more efficiently as well.