Key Insights On Returning Athletes To Sport After Injury

Charles F. Peebles, DPM

   Athletes are passionate about pushing their bodies to the highest level. The difficulty occurs when this athletic passion runs directly into a fracture, tendon rupture or other potential need for surgery (elective or not). The athlete’s mindset is to keep going and keep pushing forward while our desire is to put on the brakes and give the body the rest it needs to heal.

   Often we cannot rush the timeline for healing and this is where patience comes into play. The desire to return to activity or training may override common sense, and we need to manage this in order to prevent further injury to the athlete.

   The simplest way to describe how an athlete thinks is the saying “What does not kill you makes you stronger.” Athletes do not want to stop training. Therefore, an injury they cannot truly “see,” such as a stress fracture, does not instill in them the need to stop their activity. The physician’s role must be one of protecting the athlete from further injury and this sometimes means making the tough decision to tell the athlete to stop his or her activity.

   We need to explain to athletes the risks of continued activity or returning to sports too early, and the potential for even longer downtime. This may help convince an athlete of the appropriate treatment plan. Working together and ensuring open communication will assist in transitioning the athlete back to activity at an appropriate time.

   Our expectations in treating patients are for them to get better and return to a level of function equal to what they had prior to injury. The athletes’ expectation is to return to pre-injury activity as soon as possible and not lose any time in training or lose any of the skills they have developed. A meshing of the two must occur and communication is the key to fostering this plan.

   Most athletes know and understand their bodies well. They want to understand what happened or what is going to happen, and get a relative idea of how long it is going to take to recover. When dealing with stress or acute fractures, we can establish a general treatment timeline based on past experience. Tendon injuries may have an extended timeline as do sprains and strains, depending on the severity of the injury.

   When surgery is involved, it is important to detail to the patients the initial limitations and educate them on the normal complications that may occur. Complications include stiffness, edema and residual pain that may often delay their return to function. This may be very frustrating for the athlete. However, if one is able to clarify expectations and develop appropriate protocols, the physician and athlete may make progress and maintain some level of fitness.

Emphasizing The Importance Of Active Rest And Alternative Fitness Activities

   Active rest may seem like an oxymoron. When an injury occurs, one must incorporate a period of rest into the treatment plan in order to stabilize and prevent further progression of the injury.

   Active rest allows the injured extremity to rest while the patient maintains fitness through alternative methods. This occurs through the principle of cross training or the implementation of other activities. Many methods of active rest are available and patients can adapt them depending on the injury. A patient with a stress fracture must avoid stress on the injured area but is not required just to sit.

For example, a runner with a stress fracture has the following alternatives:

   • swimming;
   • using an elliptical trainer;
   • deep water running (water has over 700 times the resistance of air and therefore helps the athlete maintain fitness and strength);
   • cycling or spinning (ensuring the athlete is staying in the seat to eliminate the driving pressure); and
   • weight training.

   Patients can modify many of these activities and use them during the postoperative period after many forefoot surgeries. This may require shoe modifications and activity modifications to ensure patients do not do too much too soon.

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