Orthopedic Specialists

A Safe Return to Sport

August 11, 2020

Since the beginning of the COVID-19 pandemic, athletes have found themselves in the place they never wish to be found…on the bench. Unfortunately, for the past few months, our athletes have only been able to dream of being on the field, court, track, or mat. Hard work in years past has been sidelined only to hope for a chance to resurface and compete. Now as we begin to see these school-aged athletes return to sport and training, it is important we understand the effects COVID-19 has had on them and their athletic performance.
Athletes have been separated from their regular sport specific training and routines for a prolonged period of time due to the recent pandemic, and with that they have deconditioned and lost injury preventing strength, coordination, power, and endurance. The incidence of non-contact and contact related injuries increases significantly when returning to sport following prolonged inactivity. Furthermore, student-athletes may also find themselves at increased risk of injury due to embracing a mentality that “more is better” when they are trying to make a starting roster. Mounting evidence exists showing the relationship between a steep increase in training/activity and onset of injury. According to AIS (The Australian Institute of Sport), “When full training decreases by 4 days or more, a clear return to a full training plan should be implemented. It is recommended that the coach develops and implements this return to a full training plan with their interdisciplinary support team (including but not limited to physiology, medicine, strength and conditioning, physical therapy, nutrition and psychology).” Now is the time to truly take a safe, coordinated, and progressive approach to assure these individuals can participate in the sport(s) they love.
Systematic progressive training will properly prepare an athlete for their sport specific demands, and optimize both safety and performance for each individual athlete. According to the U.S. Council for Athletes Health (USCAH), it is critical to understand the concept of a “transition period” – defined as “a specified amount of time that is required for an athlete to GRADUALLY adapt to full training and sport activity following a period of inactivity or a change in activity (i.e. new training technique, a new coach).” These transition periods are vital, and when utilized correctly will prevent injuries and significant health issues occurring among athletes (such as Exertional Rhabdomyolysis and Exertional Heat Illness). 
The first step in a safe return to sport is determining the current baseline of each individual athlete NOW and NOT where they used to be last time they were at training. An athlete’s current baseline with fitness and athleticism is dynamic due to many factors including nutrition, hydration, sleep, coordination, strength and endurance. This will allow the supporting staff around that athlete to build a directed and individually unique approach to return them to sport properly, and to optimize their performance.
As stated by the USCAH:
The following principles must be considered in this process of creating and implementing a Plan for Return to Sport for your organization.
1. The plan must be based on sound, evidence-based principles developed by leading experts in the field of health, sports medicine, and sports performance.
2. The plan needs to be communicated and transparent with all stakeholders including athletic medicine staff and the student athletes – everyone needs to understand the process for a safe return of full activity.
3. The implementation of the plan must be intentional and monitored by a sport performance professional or a sport coach if a sport performance professional is not available.
4. Coordination of all aspects of the student athlete’s life is critical during this transition period – including strength training, conditioning, sport specific activity, recovery, sleep, and nutrition.
5. Perhaps the most significant component of the plan is the creation of a process to focus on the mental health and emotional well-being of the student athlete.
Once a baseline has been established, it is essential that a “one-size-fits-all approach” is NOT used with strength and conditioning training. No one athlete is the same, no one athlete starts at the same baseline, and no one athlete is at the same stage of physical development. Even more so, these athletes have not been acclimatized to our increased summer heat with the addition of sport specific demands. Thus, it is very important we don’t rush back to sport because we can, but instead return back to full sport when it is right and they are ready to compete safely.
We miss our athletes, and our athletes miss their sports; however, it will be even worse if the opportunity to return arises and an injury occurs from overuse that could easily be prevented by both the athlete and the coaching staff. Don’t just do it, but do it right.
Resources for Further Education on injury prevention and safe return to sport:
1. National Athletic Trainers’ Association Position Statement: Prevention of Pediatric Overuse Injuries
2. National Athletic Trainers' Association Position Statement: Preventing Sudden Death in Sports
Iowa Specialty Hospitals & Clinics is available to help athletes seeking assistance as they return to sport training and activity.  To learn more or to schedule an appointment, call 515-532-9265 to speak to a member of our physical therapy team.

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