The Importance of a Return to Play Program After Physical Therapy

For teens and collegiate athletes who compete at a high level, suffering an injury is commonplace, if not downright expected. In fact, a study conducted by researchers at Sweden’s Karolinska Institutet found that during the average week, one in three athletes was injured. The high risk of injury in competitive youth athletes shows that early intervention injury prevention and return to play protocols are needed in order to avoid long-term consequences of injury.

Bill Parisi recently sat down with Nick Peppes, PT, OCS, MDT (NP) and Dr. Damion Martins (DM) of Atlantic Health Systems in Morristown, NJ to discuss the topic.

How important is it to have a synchronized return to play program post physical therapy?

NP: Every physical therapy program begins with addressing pain, function, flexibility and strength. For example, an ankle sprain will have swelling, pain and limitation in range of motion (ROM). As a physical therapist, my first priority is to reduce pain and swelling and help the patient to resume normal activity.

When ROM returns and strength reaches normalcy, we can begin with sport-specific movements. For example, a soccer player would perform half-speed jogging and cuts. We monitor progress from there, and at this point, the patient might even be discharged.

Restrictions on insurance benefits limit how long someone is able to utilize physical therapy. They may only be allowed a certain number of visits per year, and some patients choose not to utilize all of the visits in case they are needed for a second injury at another point in the year.

DM: Athletes need to return to play with a decreased risk of re-injury, which is more common than we’d like to see, especially with ACLs.

In football players, athletes are 6x more likely to tear the opposite ACL after an initial tear, often due to a genetic collagen deficiency which has been studied more in the last five years.

The American Journal of Sports Medicine found that 30% of patients sustained noncontact re-injury or tore their ACL within 2 years of surgery.

NP: A structured return to play program really helps in the transition. The post-rehab program bridges the gap between therapy and full play.

How can a parent ensure that they have the right return to play program for their child?

NP: There are a number of things that a parent should look for in a return to play program for their child, such as:

• Good interaction between personal trainers and physical therapists. That interaction is vital to prevent re-injury. Physical therapists can instruct which movements to avoid and monitor.
• Qualified trainers with credentials and experience working with post-rehab patients.
• Trainers should have familiarity with the conditions therapists are treating and restrictions that might be put on some athletes.
• Parents should receive feedback from trainers. Are they making progress? Are there specific areas needing improvements?
• The program should include standardized testing, such as the Functional Movement Screen (FMS), and periodic re-testing.

How long should a return to play program last for?

NP: It really depends on the athlete and the severity of the injury or surgery. For example, a simple ankle sprain could be 3-4 weeks. If it’s post-surgical, like an ACL tear, it could be more like 2-3 months. It’s important that any program treats the athlete as a whole to avoid contralateral injury, especially in ACLs.