This is the quick version for my “return to play” criteria. The “Why” and explanation of how to make this work in a school setting is in the full article
This is the “quick version” 2 steps to a better recovery.
#1 Use “Pennies”
In the upper-level sports teams, college and professional – the use of different colored jerseys or “pennies” is extremely common.
These pennies allow for immediate recognition to the coaches, players, and staff, both in live practice and video review, that the athlete is not 100%.
They allow for the athlete to still be present, play in correct positions, see in-play and practice procedures, gain and continue game-time decision making, continue grooving sports movement, and get off the sideline.
We all want the athlete to be participating with the team.
Teammates can easily recognize the injured athlete is not 100% – so contact, speed, etc should be appropriately controlled so as to allow for recovery.
Coaches can evaluate practices with the understanding that the athlete is still being fed week-by-week adjustments. It keeps the athlete engaged mentally while giving staff the ability to remember the athlete may not be fully functional in practice but with the understanding that by game day, they may. Reps, even at a reduced speed, team contact and ability, are infinitely better than no reps and I think everyone interested in modern-day recovery can agree rest alone is almost never the best recovery option.
My suggestion: use pennies for non 100% athletes in nearly every practice. Create a color system that makes sense for your sports med and coaching staff. It makes for simplicity with practice review and video reps. Get and keep the athlete on the field.
#2 suggestion: Running a 6 Step return to Play protocol for all injuries.
I utilize a 6 step recovery to 100% model for low grade injuries.
Day 1 : 50%
Step 2 : 65%
Step 3 : 75%
Step 4 : 85%
Step 5 : 95%
Step 6 :100%
The athlete can not go past his assigned percentage for each day.
If the athlete passes the day with no setbacks or recurrences he/she is moved up the chart to the next percentage.
If there is a re-exacerbation, the athlete stays at the same percentage for the following day or a reduction in percentage based on the Athletic Trainer’s and coach’s discretion.
Further therapies, rehab techniques, clinical work, etc. is done IN ADDITION to practice, not in substitution of.
Here’s the deal. We need intel to help us decide if the athlete can return to competition. Rest, 10 point pain scales, “How are you feeling today?” and max effort with no sub-max testing is a poor way to make a decision for your athlete’s health and recovery.
Certain max ability drills such as sprints, gassers, max out weight room workouts, etc are not done until the athlete can tolerate them. The additional therapies required for maximal recovery may work into these time slots.
By game day, the AT and the coach will have a good “working idea” of the athlete’s ability and chance of exacerbation and re-injury.
The reality is in all sports, the athlete may not be 100% in each case. I’m not suggesting 100% before competition as I think that’s another “on paper” reality that isn’t a realistic in the sports world. By 6 games in to a typical high school football season, I would argue, no one is 100%. I bring this up because I had conversation with an athletic trainer that didn’t want his athlete’s seeking out my care as a sports based chiropractor because he had a policy of “100% healthy or No Play.” This meant that if they were seeing me for a pre-game “tune-up” , it equated to being injured and he threatened to sit athletes out of competition that week.
The reality of this is that athletes rarely would seek out treatment form the athletic trainer for fear of being benched for little tweaks or tight muscles. They knew that if they had any reported “complaints” it was viewed as injury.
This is a double kill situation where the athletic trainer saw very few athletes. He could go about his day blissfully unaware of basic, simple care his teams would benefit from – completely confident that his teams were perfect with no complaints. The actuality was no one dared seek their team’s “professional.” The coaches wouldn’t use him as they knew he would sideline their players, the parents used outside staff exclusively for the same idea and the athlete’s themselves had no confidence or even worse were scared to talk to the athletic trainer about injury or sports performance. The best qualified member of the staff was “out of the loop.”
Back to “return to play…”
ATHLETIC TRAINERS AND COACHES ARE THE BEST JUDGES OF RETURN TO PLAY, not doctors.
The alternative to doing what I feel is correct, is rest. Wait for a release from a doctor that doesn’t have any way to make a decision other than allotted time, and I feel, a significant chance of re-injury, as the athlete has had no ability to re adapt and prepare for the demands of competition. Doctor’s in a clinical setting have no ability to properly evaluate sports specific movement. A policy of a doctor’s release is a poor policy.
Recently, while discussing this with a few of my local high school Athletic trainers, we have decided to push for a better policy. A letter from the primary to be stated, “Released for Return to practice and Competition under the Athletic Trainer’s and Coaches discretion.” This, in my opinion, is all that is needed for a much better system and policy. I present these and other protocols as a part of my career. I would be happy to help set these policies up for your school sports medical staff as an in-service. Just contact me.
I understand there needs to be policy. I understand that policies at certain districts are at odds to my proposed ideas. Understand this article is a very generic, very vanilla return to play criteria offering an improvement in the current status quo with minimal effort level. It benefits the athlete, the team, the coaches and the training staff. It isn’t created to circumvent policy but to focus on the fact that the sports arena as a whole has a lot of gray areas and a one policy for all, is a dangerous concept and often not in the athlete’s best interest.
Obviously, any criteria for an injury and return to play is a case by case scenario and should be adapted for each individual case to best match the needs.
We are having the return to play being either negated or done sub-par in cases.
Often it is by the wrong provider based on circumstance and perhaps policy.
Policy should reflect what is best for the athlete, not be based on the degree of the practitioner.
I argue that the Athletic Trainer with help from the coaches is THE BEST qualified people to create and implement return to play criteria, not a note from an ancillary provider.
Communication helps. Use the information from the ancillary staff to help make better informed decision in certain cases. A text or quick call makes a huge difference.
Return to Play can be fairly simplistic and done in a way that benefits…EVERYONE.
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