Return to Sport (lower limb injuries)
Getting back to sport after an injury can certainly be nerve racking. Particularly when you've spent weeks or months on the sideline. Injuries or pain in the lower limb, particularly involving the hip, knee or ankle make up a large proportion of sporting injuries, especially in field and court sports.
Say you've done all the hard work and feel like you're close to your best, how do you know when you're safe to get back to training and playing?
Well, it depends.. Return to sport timelines can be affected by any of the following factors:
The type of injury i.e. what structures are involved? Bones, tendons, muscles, spinal discs, cartilage and ligaments all have differing timelines for recovery. This is because they are made of different types of cells, and have differing blood supplies, as well as different abilities to become inflamed.
Severity of an injury - this will affect your timeline to return due to the degree or amount of tissue involved in an injury. Essentially – the greater severity means it will take longer to heal fully.
Relative rest – I say relative because we should very rarely be resting completely when injured. Physical activity, movement and exercise can help aid tissue healing and recovery. So playing PlayStation on your couch while recovering from an ankle sprain isn’t going to be helpful.
Rehabilitation adherence – Working with a physio can be useful to minimise your time on the sidelines. Physiotherapists (or any other clinician) can’t magically heal you with any amount of massage or theragun application. But maintaining strength, mobility and conditioning means that when the injury is ready, so will you.
A load of other factors including age, genetics, general health and even your diet and sleep can affect recovery times.
When I'm helping someone rehabilitate from lower limb injury, I'll utilize a range of tests measuring flexibility, strength and power as a means to determine their readiness.
Here are a couple of the tests I commonly use:
Lateral hop test: This can help identify tolerance to change of direction, particularly after a ligament/joint injury.
Triple hop test: This is one of a few versions to check strength, power and capacity to absorb large forces when playing sport.
If I can observe symmetry in testing between the injured and uninjured limb, this can be a good indicator of readiness. There is also some data available regarding normal values for these tests, so we can check if your results compare to other athletes.
Just as injuries can be complex, so can a return to sport. Along with these tests I might look at certain strength tests and pain provocation tests. If an athlete tests well then we will begin to consider a return to training. This might look like involvement in some simple drills, progressing to competitive and more complex drills as the injury allows.
Once a return to sport (competitive matches/games) is considered, it can sometimes be wise to introduce a minutes restriction to minimise fatigue and injury risk.
As you can see, this is complex. No two injuries, no two athletes, and no two rehabs are ever the same. One of the many reasons why I love my work.
