Saturday, June 1, 2013

Returning From Injury: The Most Importance Clearance

BY DR. PHIL WAGNER, M.D.
 http://spartascience.blogspot.com

 The most common question in any injury is simple;

WHEN CAN I PLAY AGAIN!?!

This answer to this question of return to play is critical because previous injury is the #1 cause of any injury, whether it is a concussion, sprain, or pulled muscle (see Sparta Point).



Return to Play refers to the point in injury recovery when an athlete is able to go back to playing sports at a pre-injury level. The process begins after the acute phase of injury, which can last up to 3 days after the injury (see Sparta Point). Unfortunately, after this normal initial healing response, medical recommendations are primarily very time focused. For example, 6 weeks is a common response, as it is the average healing time for soft tissue (bones, muscles, etc.).

Yet, we train and play in a meritocracy, so we shouldn't we base our Return to Play decisions the same way?



Choosing a Baseline Test for Your Meritocracy

The first step is to choose a baseline test, a point of reference, ideally the level of performance before injury OR a normal score for your peers. The value cannot be the sport itself, but rather some form of measurement that has or can occur during training.

The keys to finding a baseline test is to find something

  • objective
  • repeatable (avoid too long between follow-up tests)
  • reliable (dependable)
We use a force plate because it has been proven superior in the above 3 requirements. More importantly, it is valid, measuring the foundation through which all things flow, ground-based strength (see Sparta Point).



To make it easier to understand, we name our Return to Play phases based off their clearance; quantitative standards required for the athletes to move onto a higher level of participation.


Clearance #1 = PAIN

If surgery occurred, athletes have to be cleared by a physician for at least jogging, otherwise the only requirement is no pain during the brief dynamic warm-up to actually perform the baseline test, which is the force plate in our case.


Clearance #2 = QUALITY

Once you have your test, previous research has indicated 85-95% of baseline is your key to return to play, generally comparing the injured to the non-injured side, or even better, their previous best performance.

The reason for 100% being unnecessary is that most tests, even the force plate, has a daily variation of a certain percentage. This natural fluctuation does not necessarily reflect a better or worse performance than the previous test. Therefore Return to Play does not require 100%. To achieve clearance, athletes must attain 90% of their previously lowest value on the force plate, or all variables need to be within 10 points.

Unfortunately, this movement efficiency or quality Return to Play, is often skipped because it is hard to find objective tests for quality movement, and everyone is always eager to return as quickly as possible. Make no mistake, the order of clearance importance is as written and skipping this phase occurs at your own peril.


Clearance #3 =QUANTITY

Movement quality, or efficiency, can improve physiological processes like heart rate and cardiovascular indices. BUT, fitness is less likely to improve the physics of HOW a movement is done.

So once quality clearance occurs, the next step is to return the athlete to a level of fitness acceptable for play, ideally using movements close to the required movements in your respective sport. For example, lower body injuries must be able to maintain a baseline in sprinting and change of direction activities, while upper body injuries should be bolstered against swinging or rotational movements.


In the coming weeks, we will start outlining some blocks we prescribe for quantity clearance, but in the meanntime, what is your quality clearance ?

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