Here at ABSOLUTE.PHYSIO we have had quite a few people ask us in recent weeks, ‘when will I be ready to return to sport after my injury?’ This is always a consideration for patient/sportsperson and physiotherapist alike, and is always a ‘hot topic’.
Anyone who is a football fan and has an interest in the English premier league will have seen this topic well publicised recently in relation to the plight of Belgium and Manchester City footballer Kevin De Bruyne. De Bruyne suffered ligament damage to his right knee during a training session in August of 2018. After investigations on his knee, it was reported in the media that he would miss approximately 3 months of action. Despite these reports, De Bruyne returned quicker than anticipated on the 20th of October, 4 weeks ahead of schedule much to the delight of Manchester City fans and all those managers of fantasy football with great aspirations!
However just 12 days and 4 matches later De Bruyne suffered another knee ligament injury, this time to his left knee, which has now ruled him out of sport for another reported 4-6 weeks. This has garnered many questions about whether De Bruyne was ready to return to such a high level of competitive sport and how do medical professionals such as physiotherapists determine when someone is ready to return to sport?
Unfortunately, there is no simple or single answer here and instead those decisions are based on the consideration of multiple aspects of the injury and the sport which all need to be addressed before returning. A guideline of how an athlete should tailor their return can be found in the image above. The first issue which is usually addressed is pain. Pain is the body’s response to actual or perceived damage to the body. It is our brains way of warning us about the activity we are doing. In most cases pain is the biggest indicator for an athlete to stop with their sport and can be the biggest barrier to overcome in order to return to sport. Physiotherapy can help by teaching athletes about their pain and techniques on how to manage and reduce it.
The type of injury plays a major role in when someone can return to sport. Not all injuries heal at the same rate and people with a similar injury may take different lengths of time to recover. The image below created by Physio Network from the results of a study by Vuurburg et al. (2018) shows how the recovery time for an ankle sprain may differ. Strength deficits, reduced ranges of movement, poor biomechanical actions and practice of sport specific drills will require attention before an athlete can return safely to sport following an injury and these are best addressed by consulting a trained expert such as a physiotherapist. The effect of fatigue also needs to be considered as studies by Dr Matt Greig have shown a decrease in muscle strength as an athlete fatigues which can then lead to an increased risk of injury. Interestingly, De Bruyne suffered his second injury in the first game which he had played more than 1 hour of football.
Psychological factors are often an overlooked aspect of returning to sport. These can be driven by either internal pressures the athlete places on themselves or external factors placed on the them from other sources. Internal pressures would include, fear of re-injury, anxiety, depression and frustration at time out of sport. External pressures would include fear of losing place in team and managerial pressure to play. These should all be considered before an athlete makes a full return to sport. Some of these factors may lead to an athlete trying to return too early others might result in a delayed return even though the body is now healed. Recognising and addressing these factors can be just as important as recognising and addressing the physical responses of injury.
In summary there is not one answer to the question of when someone is ready to return to sport. For optimal recovery time and the lowest risk of re-injury, the return to sport following an injury should be guided by a recognised medical professional to ensure all athletes return to their desired level of sport.