How to return to play after a sports injury the right way
Did you ever wonder what you should expect when you attend physiotherapy for an athletic-based injury?
My first sports-related injury was in high school and I didn’t know what to do. I could barely stand on my left foot, let alone play basketball. My coach suggested that I book with a physiotherapist to get it looked at. So, I booked an appointment. I wasn’t sure what to expect the first time I attended physio; to be honest, I was a little nervous. I received passive treatment, which refers to heat or ice and machine-based modalities (e.g. ultrasound, interferential current (IFC), or traction), and some hands on treatment. Hands on treatment from a physiotherapist can include, but is not limited to, massage, mobilization of joints, or manual traction.
Before I would leave each treatment, my physiotherapist would tape my ankle and tell me to weight bear as tolerated. As my understanding of injury rehab started to increase over the years I thought this was all that was needed. Don’t get me wrong, these are all good components to include within a rehab program, however, the most important piece of the puzzle was sometimes missing. So what is the most important piece of the puzzle? The answer is exercise!
Depending on the severity of the injury, the exercise starting point will vary. The general progression should focus on mobility through stretches or range of motion exercises, muscular endurance, muscular strength, and finally working on power.1 The progression should allow you to gradually return to your sport movements in a slow controlled manner and finishing with the rapid movements. These progressions are known as periodization, which is a systematic way of training to reach performance goals. Typically our physiotherapist in Grande Prairie will take you to the strength development phase of your rehab and allow your coach or strength and condition coach to continue to progress you through the power development phase.1-2
What do each of these phases look like from an exercise perspective?
Mobility and Range of Motion
This phase focuses on getting the joint moving near the injuries. It may involve some stretches where you hold your body in one position or involve moving the joint around to the best of its ability. Examples of mobility exercises include:
Picture 1: Lying chest stretch.
Picture 2: Ankle mobility exercises.
This phase focuses on lifting light weight for several reps. Muscular endurance is important to increase the ability of the muscle to perform a movement over a prolonged period of time. There are very few sports that do not require some level of stamina or endurance to play. Your physiotherapist will often have you working on 10- 15 reps of the prescribed exercises. Often times, therabands or resistance bands are used during this phase. Examples of muscular endurance exercises include:
Picture 3: Seated chest press with theraband.
Picture 4: Ankle strength with theraband.
This phase focuses on increasing the strength of the muscles worked in the previous two phases. Your physiotherapist will start to increase the weights and lower the number of reps completed. The goal is to increase the strength of the muscles and prepare them for the power phase. Power development is not safe until the body has adequate strength. If the injured muscles are lacking in strength then the risk of re-injury remains high. With adequate strength, the body is able to move into the power phase and return to sport without being re-injured quickly. Examples of muscular strength exercises include:
Picture 5: Squat with medicine ball.
Picture 6: Dumbbell bench press.
This phase focuses on completing movements quickly. This phase helps prepare athletes to return to sport so that they can tolerate the dynamic movements to complete the required skills. The reps will again be reduced but the exercises will be completed at close to, if not, full level of effort. Examples of power exercises include:
Picture 7: Chest ball throw.
Picture 8: Lateral squatter jumps.
Research supports this progression through exercises in the rehab setting for sport-related injuries.1-2
- Lorenz DS, Reiman MP, Walker JC. Periodization: Current review and suggested implementation for athletic rehabilitation. Sports Physical Therapy. 2010; 2(6): 509-518.
- Hoover DL, VanWye WR, Judge LW. Periodization and physical therapy: Bridging the gap between training and rehabilitation. Physical Therapy in Sport. 2016; 18: 1-20. http://dx.org/10.1016/j.ptsp.2015.08.003.