How long until I can go back to sport?
A very common question we get asked in the clinic is 'How long will it take me to get back to sport with this injury?'. On the surface it seems like a pretty simple question. My injury is 'X' and therefore it will take 'Y' amount of weeks to recover. After all, my body will heal back to 100% regardless of what I do, right? Unfortunately not. All too often we see recurrent injuries in athletes because simply rest and return to training or matches when they feel ‘ready’. Despite the sensation of ‘readiness’, an assessment may reveal worrying musculoskeletal deficits and identify a high risk of re-injury if a player were to return to their sport too quickly.
After sustaining an injury, a thorough physiotherapy assessment may provide a good estimation for when an athlete may be able to participate in sport after an injury. However, our focus as a physiotherapist is based on achieving certain milestones or goals rather than simply allowing a number of weeks or months to elapse. This is the concept of ‘Goal Based Rehabilitation’. Not only does Goal Based Rehabilitation ensure that an athlete returns performing at their absolute best, but will also drastically reduce the likelihood of recurrent injuries. Conversely, ‘Timeframe Based Rehabilitation’ may set the unrealistic expectation that the body’s natural healing processes alone are sufficient to adequately prepare an athlete for sport.
Let's provide a bit of context: If a local footy player strained their hamstring, how long will it take for them to return to playing matches? Firstly, an estimation of a timeframe for their return to play will be based on a number of factors, such as their symptoms, the severity of the injury, the mechanism of injury and whether the player has a past history of hamstring strains. For arguments sake, let’s say that the player was provided with a prognosis of 4 weeks until they can return to matches. What needs to happen in the next 4 weeks so that player can return to competition safely?
Put simply, the player should aim to regain the strength, length and function of the hamstring muscle group, all whilst maintaining as much fitness as possible. So in terms of milestones to reach before returning to play, I would want an athlete to be able to:
1. Complete a similar number of hamstring strengthening exercises (usually hamstring bridges) on their right leg compared to the left. A certain number of repetitions should be accomplished on both legs and is dependent on the athletes age and demographic.
2. Have a similar amount of muscle length or ‘stretch’ when performing a number of different hamstring stretches on both the right and left legs
3. Complete a graded running program, which gradually progresses from walking or jogging through to sprinting. There should be no pain or perceived tightness in the injured hamstring.
4. Maintain their fitness through specific modification of strengthening exercises, avoiding aggravation of the muscular strain.
5. Gradually return to pain free training, starting with light skills through to full intensity training. Training should aim to simulate match play. Typically, we would want to see 2-3 full intensity training sessions.
6. Finally, the athlete should feel confident and ready to perform.
This would all be completed within a thorough ‘Return to Sport’ physiotherapy examination. Albeit the list I have provided may seem comprehensive, there are many other identifiable risk factors for hamstring strains that I haven’t mentioned which may modify the athletes goals and rehabilitation program.
Ultimately, returning to playing sport after an injury is a lot more than just a time frame. A greater awareness of goal based rehabilitation rather than timeframe based rehabilitation is a much needed shift in the mind set of many coaches and players, particularly at the grass roots level of sport.
Lachlan Cooper, Physiotherapist Back In Motion Rowville
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