Phases of Rehabilitation - Return to Play

Good Morning! Happy Monday!

The first thing I have to bring up is UCONN’s win against Duke yesterday. That shot was insane. At one point UConn was down by 19, just to defeat Duke with a half court buzzer beater. Crazy ending.

Today, I’m going to talk about the 4th stage of rehab, the return to play phase

*The injuries discussed in this newsletter are for general educational purposes only. I am not affiliated with the athlete’s medical team, and the information shared does not reflect any insider or team medical details. Specifics about the injury are often unavailable, which can significantly influence the estimated timeline for return to play.

Return to Play

This phase is self explanatory. The athlete is being prepared to return to play with sport specific movements and testing. This will allow the safest way to return back onto the field without a high re-injury rate.

Stress and Strengthening

In the return to play phase, stress with exercises will be applied with multiplanar movements. As I explained in previous newsletters, football requires movement in all three dimensions at the same time. In order to create sport specific movements, programming exercises like a lunge with an upper body rotation holding a kettle bell or medicine ball can achieve this. Or potentially it could be a banded hip adduction with internal rotation of the hip because these two motions are coupled together.

Exercises will also continue strengthening outside of neutral. However, it will include end of range of motion rate of force development. Rate of force development is how fast the body can produce a lot of force (in other words, very similar to power). This not only helps the athlete’s performance but additionally helps prevent injuries, being at end range to absorb a large amount of force (falling on an outstretched hand).

Practice Modifications and Volume Progression

Jumping from no practice to full practice can be dangerous for an athlete. Modifications in their practice can help safely return them back to the field. This allows their body to adjust to the speed and requirements practice demands.

Often practice modifications would include the athlete only participating in non contact individual drills. This generally has the least amount of stress on the tissue. Then they can progress to limited competitive reps in one on ones or 7 on 7 which are generally non contact but contact often occurs. And lastly progressing to full team (11 on 11) reps in practice.

In some cases, practicing one day with the modifications, then taking a day off can also be a plan of action. To give the tissue an extended period of time to recover. Then progressing to back to back days and eventually to full participation.

As the athlete gets closer to full participation mimicking the level of intensity of practice can be beneficial for the athlete to get used to the flow of a practice week. Meaning, if tuesday is a hard practice, rehab will be harder. Then if Wednesday is a walk through, rehab will focus on range of motion and recovery with less intense exercises.

Metrics

Test and metrics play a larger role in this phase for clearance to play. This can look different for different sports, different teams, different levels of athletes, and even different positions!

In some cases, where catapult data is used, a certain velocity must be met for a skilled player to be cleared to play (18-19 mph). In other cases, a sports medicine team might want an athlete to accumulate a certain amount of total yards and high speed yards based on the position they play in rehab to simulate the normative data for a general practice.

And of course, depending on the injury, return to play criteria must be met and sport specific movement on the field needs to be assessed by a practitioner and by the athlete themselves if they feel comfortable with that specific movement.

*Due to my professional association with the Atlanta Falcons during preseason and my current role with the Florida State Seminoles, I will not provide educational content or commentary on any injuries within these programs during or after the season.

This wraps up the 4th phase a rehab. The last phase, which will be covered next week, is the Return to Performance phase!