Key Insights On Returning Athletes To Sport After Injury

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Author(s): 
Charles F. Peebles, DPM

   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.

   Give patients a detailed list of what activities are acceptable. Explain that running, aerobics, fitness walking and many sports are impact activities. The activities described above (swimming, cycling, elliptical, etc.) are non-impact activities and athletes can begin these much earlier without risk of further injury.

   This phase of active rest transitions the athlete from immobilization (stabilization) to maintaining fitness while the injury or surgical site heals appropriately. During this phase, one should further address the underlying etiology of the condition (assuming it is not an acute fracture or rupture).

   One can address issues such as osteoporosis, nutrition, biomechanical abnormalities as well as equipment or training problems. It is important to identify these issues early in this phase so when athletes are ready to return to activity, they do not need to await further evaluations. As the athlete progresses, it helps to develop a plan for return with both the athlete and coach in order to facilitate an appropriate gradual return to play.

Pertinent Pointers For Easing Patients Back Into Activity

   One of the biggest mistakes one can make is to attempt to return athletes to their activity of choice too quickly. Many physicians tell their patients
to “take it easy.” Unfortunately, this is very vague and the competitive athlete often does not know how to accomplish this safely.

   The most effective method for returning to activity is to gradually increase stress on the body and the healing limb while allowing time for recovery. This can occur through a variety of methods and the athlete must understand the need for patience in this return.

   One key in rehabilitating athletes is to remember that they may still effectively perform other aspects of their sport (free throw shooting, weightlifting, catching) without the need for significant stress on the lower extremity.

   A major component of most athletic activities is running and the following example outlines the return to running activity. Returning a runner to running should begin with active walking to begin to place stress on the body. The athlete should then begin a run/walk and progress to full running with a written plan to follow. If limping occurs, the activity level should decrease so as not to create compensatory injuries. Continue to monitor the athlete for healing through clinical and radiographic evaluation.

   Retraining of the body in the competitive endeavor is important to prevent recurrence of the injury. It is important to discuss the normal pain that may occur with osseous or soft tissue injury so patients will have an understanding of what is and is not a concern.

Crossing The Finish Line

   Returning to full activity may seem like a slow progression for the athletic patient. However, by ensuring effective communication and providing activities they can do to maintain fitness, athletes can return to full activity with limited downtime.

   When athletes have injuries, their normal activities take on a completely different meaning given that the demands on the body are much greater with athletic activities and the lack of patience many athletes have. It is essential to not only properly diagnose these injuries but provide opportunities for active rest and a progressive return to activity. The coordination of the patient’s expectations and the physician’s experience allow athletes to resume their passion in the most effective and expedient way.

Dr. Peebles is a Fellow of the American Academy of Podiatric Sports Medicine and the American College of Foot and Ankle Surgeons. He is the team podiatrist for the Atlanta Hawks and has a private practice in Atlanta.

Dr. Richie is an Adjunct Associate Professor in the Department of Applied Biomechanics at the California School of Podiatric Medicine at Samuel Merritt University. He is a Fellow and Past President of the American Academy of Podiatric Sports Medicine.

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