When Can I Return to Sports? - KIME Physical Therapy

When Can I Return to Sports?

January 06, 2021 | Tony Mikla DPT

The hardest question for me to answer with ACL patients was, “When can I go back to my sport?” And for me to give an honest answer and say, “I’m releasing you to go all out, no restrictions, and I promise there will be no non-contact re-tear on my watch”… that was always hard to say. At the time, I didn’t feel like there was any concrete information that I could give to the patient or test them with to really, truly say that. It really brought on this need to create a scorecard that encompassed all different facets of the challenges they’re gonna face on the field and the court. So that’s what we did.

We dove pretty deep into some different research that’s out there, from jumping to performing under fatigue, to typical strength and stamina tests. We created this amazing tool that we use to definitively say, “You are ready because you did these things. You developed yourself in strength, in movement, in speed and impact, in power, in a sport capacity, and in a way that I feel confident you can go out there and not injure yourself.” And we want to give this tool to you.

In school, they give you one test here and one test there. But the reality is, there’s not one test. Too many people rely on one measure, and it’s really commonly a power test like the triple hop. What I can’t stand about one measure is you’re forgetting that athletes know how to cheat. I saw a kid with an injured knee dunk off of that leg, proving to me that you can explode off of a leg with a very problematic knee. So to rely on a single power test that incorporates the whole limb is not the right way of doing it. You can cheat that test and you are an injury waiting to happen. We need this comprehensive look at movement, movement quality, strength, power, impact tolerance, and sport progressions. That’s the best part about the scorecard, is that it takes everything into consideration and breaks it down to truly understand someone’s ability to return to their sport.

More than just for the patient, a big element to the scorecard is it really guides a thought process for the therapist. The question most therapists ask is: “Where do I need to take this person?” The scorecard lays out an all-inclusive blueprint for any therapist to look at and check each box. It also keeps the patient in check, because at some point they’re going to ask you when they can return to their sport. They’ve done everything you asked to that point, they move great, they feel great, and you’re still causing a restriction on their return to play. The research tells us that every month you wait from six months to nine months, you reduce your risk of re-injury by 50%. And the scorecard gives the patient and the therapist the data under a certain threshold to say, “You’re not ready but I know exactly what you need to get ready.”

But again, it’s not that you need to get the athlete to pass the test, that’s not the point. It’s to make sure that you’re accomplishing their development in all different phases of their rehab. That you’re not letting any one aspect of their training go by the wayside. It forces you to think, and to allow physiological adaptation to happen in time. 

I hope this has helped you better understand the concept of a scorecard and how you can use a similar model to understand your own training and return to sport or that of your patients. Happy training.

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