It’s a situation no athlete ever wants to experience: injured and unable to play. No one wants to be injured, but when your career must be put on hold due to injury, rehabilitation takes on a new dimension of importance. Often athletes will feel significant pressure to recover and return to competition as quickly as possible.
It’s understandable that athletes will want to return to competition as quickly as possible. However, without a systematic approach to both the rehab process and the transition back to competition, you run the risk of reinjury or sustaining a new injury – forcing you to take more time off from competition as the vicious cycle continues to spiral. The return to sport process should be viewed as a continuum, one that measures and balances all aspects of recovery with sport specific needs to ensure that the whole athlete is ready to return to competition.
You’ve taken time off, rested, and participated in skilled rehab, now you’re ready and eager to get back on the court. BUT WAIT! How do you ensure that your injury is completely healed and ready to withstand the rigors of professional sport? Research shows that following return to sport, up to 44% of athletes will have a recurrence of Achilles tendinopathy, and up to 20% of surgically repaired ACLs will be re-torn. Additionally, in a study following shoulder injuries of major league baseball pitchers, researchers found that after returning to competition, almost 50% of players missed more time later in the season and there was a significant decline in performance when they returned to play.
So, how do you know that you’re ready to compete again at the highest level with minimal risk of reinjury?
Working with a physical therapist to complete an individualized rehab exercise program is a crucial first step toward returning to tennis, however, it is only part of the process. Too often athletes will “feel great” during a training session and then increase volume and intensity of loading too much, too quickly, leading to reinjury and prolonging time away from competition. As you progress through rehab and improve it is important to go through a graded return to play progression (RTPP). A graded RTPP will:
Not only must you treat and rehabilitate the injured tissue, you must restore functional strength and endurance as well as train your energy systems to withstand the return to competition. In the early stages of rehabilitation, this may be in the form of endurance training to maintain cardiovascular fitness. As you progress through the rehabilitation process, training should become more tennis specific, mimicking the intensity, duration, and work to rest ratios required for matches.
It is recommended to play two or more 3-set practice matches at 100% intensity prior to return to competition.
Following completion of an appropriate and individualized rehab program and graded RTPP, you should undergo functional testing to ensure adequate fitness and readiness for return to match activity. Functional tests are chosen based on the injury diagnosis and location, they are used to assess functional strength, speed, power, and agility. Results are compared to either your pre-injury test values or norms established within a similar population. Research shows there is no single test able to determine readiness to return to play, rather a grouping of tests should be chosen to evaluate all components of fitness and sport activity. Your treating physical therapist will help to select an appropriate grouping of functional tests to assess your readiness to return to play.
Several factors will determine when an athlete is ready to return to competition including:
While it may be enticing to return to competition prior to achieving these milestones, returning before your body and mind is 100% puts you at risk for re-injury, may result in more time off and decrease your ability to achieve your performance goals. It’s not only important for your injury to be fully healed, you must be conditioned for a successful return to sport!
The information provided within this Physically Speaking topic is for informational purposes only and should not be treated as medical, psychiatric, psychological, health care or health management advice. If you have any health or related questions or concerns, please consult your physician or other qualified health care professional.
A special thanks to the author, WTA PHCP, Lindsey Elizondo, DPT, ATC, LMT, CSCS