If you have had a recent injury, one of your main concerns may be how soon you can return to play. The answer to this question is not always easy because each athlete and each injury is unique. Returning too soon can increase your risk of re-injury or developing a chronic problem that will lead to a longer recovery. Waiting too long, however, can lead to unnecessary de-conditioning.
When the body is injured, for instance when you tear a muscle, the body uses a process called inflammation to try to begin healing the area. You know something is inflamed when you see redness and swelling, feel heat and pain and can’t use your body as you usually would. Often it is the presence of these signs that give us the first indication that we have sustained an injury. Whilst inflammation is an essential part of the healing process it is important to understand that this should ideally be a self-limiting process but often can cause problems when it lasts longer than it should.
There are three phases of healing: the Inflammatory Phase, the Regeneration phase and Remodelling phase. Sometimes the body gets stuck in the inflammatory phase for a long time, this is known as Chronic Inflammation. Until the inflammatory phase is complete the rest of the healing process cannot occur.
Acute inflammation – straight after an injury you will see the signs of inflammation mentioned above, often the PRICE (Protection/Rest/Ice/Compression/Elevation)protocol is used to reduce pain and help to speed recovery times.
Chronic inflammation – usually inflammation will stop once the tissue has healed and the patient is ‘recovered’, sometimes however the inflammation continues for a number of reasons which causes prolonged time until recovery. One of the causes of chronic inflammation are early return to sport and increasing your training prematurely.
Once you have finished the inflammatory phase it is important that you allow time for the tissues to regenerate and begin remodelling, it is at this time that you can commence a controlled, graduated return to sport.
Common mistakes people make when returning to sport:
- Not warming up prior to a game/training
- Not working on flexibility & muscle tightness
- Playing into fatigue
- General poor fitness
- Not allowing for adequate recovery time
- Not addressing muscle imbalances
- Not addressing Biomechanical Issues
- Not sufficiently improving strength prior to returning to sport
Guidelines for Safe Return to Sports:
- You are pain free
- You have no swelling
- You have full range of motion
- You have full (90% +) strength compared with the uninjured side
- For lower body injuries – you can perform full weight bearing on injured hips, knees, and ankles without limping
- For upper body injuries – you can perform throwing movements with proper form and no pain
- Even when you feel 100% you may have deficits in strength, joint stability, flexibility or skill. Take extra care with the injured part for several months.
General advice to prevent re-injury:
- Stay in shape year-round
- Pay attention to injury warning signs
- Treat injuries immediately
- Participate in a full injury rehab program
- Know when it’s safe to return to sports
- Stay fit while injured
- Keep a positive, upbeat attitude
- While your injury heals, try to maintain overall conditioning if possible. Try alternate forms of training such as water running, swimming, cycling, rowing or weight training of the non-injured parts.
Regaining range of motion and strength should be started as soon as possible as directed by your Physio. Use discomfort as a guide and avoid movements that cause pain. Once muscle strength and flexibility return you can slowly get back into your sport, working at about 50 to 70% max capacity for a few weeks. During this re-entry phase, functional drills for balance, agility, and speed can be added as tolerated.
What do I need to do to return to sport after a soft tissue injury?
- Allow adequate healing time pain and swelling should no longer be present
- Strength – at least 80% strength when compared to your uninjured side
- Flexibility – full pain free range of movement at the injury site, scar tissue will remain tight for between 12-24 months so you must keep up your flexibility work by stretching the injured area
- Stability – it is essential that the joint where the injury occurred is stable
- Endurance – make sure that you are able to use the body part for a similar period and in a similar manner to that of your ‘normal sport’ otherwise re-injury is likely. You may want to practice starting, stopping, changing direction and speed in a controlled environment before you return to sport
How long until my soft tissue injury will heal?
This depends on the severity or degree of soft tissue damage. The more damage the longer the recovery and the longer the rehabilitation.
- Mild damage without instability of the affected joint,
- Tight discomfort, little or no swelling or bruising,
- Minimal pain on resisted movement and no loss of strength,
- With appropriate care, about 2-4 weeks (followed by a graduated program).
- A partial tear to the ligament,
- Some bruising, swelling and local tenderness,
- Loss of the normal range of movement, pain on resisted movements and with use (walking, etc),
- With appropriate care, about 4-8 weeks (followed by a graduated program).
- A complete tear which will cause instability,
- Severe pain, marked bruising and swelling with some disability e.g. needing crutches,
- Loss of local muscle power and pain on static contraction of the muscle,
- With appropriate care, 3-4 months (depending on the severity).
What do I need to do to return to sport after a back injury?
If you have sustained a back injury whether as a result of playing sport or not it is vital that you have followed certain measures before returning to sport.
One of the most important things you can do is to improve your core strength, the more dynamic and higher level the sport, the greater core strength you need. Poor core strength predisposes us to back injuries so it is likely that your core strength was insufficient for the level of sport/work you were performing at the time. Unfortunately having lower back pain can actually inhibit these muscles from turning on when needed and this can cause a reduction in strength following your injury.
Depending on the type of sport you play and at what level, you may need to modify your training and game techniques and your Physio can help you to determine what movements put you at risk and ways to modify them so you can keep playing
How long will it take to improve my core strength?
As with any new exercise program you can expect to see improvements in your core stability after a few weeks although it may be difficult for you to notice. It is therefore important as an athlete that you commence early core activation exercises so that once your injury has recovered your core stability is already improving.
For more information on sporting injuries, and how soon you can return to your sport, talk to your friendly Gold Coast Physio today on (07) 5574 4303!