Are We There Yet?

One of the final challenges an injured athlete faces is the transition back to full participation.  In many cases, when the pain of an injury is gone, an athlete, parent or coach may feel the player is ready to return.  However, as is often said in physical therapy, “just because it feels better, doesn’t mean it is better.”  The elimination of pain alone isn’t enough.
Often pain will be gone but deficits in range of motion (ROM) and strength remain.  We see this commonly with ankle sprains where athletes return to play too early without having gained adequate ROM and strength.  They may be able to practice and play without pain but their ongoing ROM and strength deficits may promote a more chronic problem or other injuries as the body tries to compensate for those deficits.  In addition to ROM and strength restoration, end-stage rehabilitation focuses on neuromuscular control, balance and proprioception (joint position sense).
Athletes, especially soccer players, must complete very complex movement patterns with precise, split-second timing.  We’ve all witnessed this amazing athleticism on the pitch and such movement relies on more than just ROM and strength.  Exercises and activities designed to address deficits and a reasonably gradual resumption of training activities should be part of the last stages of full return to play.  This is a stage where patience is difficult but necessary.
Making a decision to return to play too quickly can ultimately effect success in the long term.