The Dangers of Returning to Play Too Soon

Patience really is a virtue when it comes to athletes and sports injuries. But too often an athlete’s passion for the game and willingness to push his or her body to the highest level is far stronger than a corresponding sense of what may be most prudent. It’s tough to sit on the sideline while recovering from an injury, but physicians, coaches and athletic trainers know all too well the risks of an athlete returning to play too early.

Lindsey Dietrich, M.D., Orthopedic Surgeon and Sports Medicine Specialist

“Trying to get back to sport before a full recovery can result in re-injury,” explains Lindsey Dietrich, M.D., an orthopedic surgeon on the medical staff at Texas Health Arlington and Sideline Orthopedics and Sports, a Texas Health Physicians Group practice. “You really have to respect injuries to bones, joints and muscles. Having experience with injuries in all levels of athletes like we do at Sideline Orthopedics allows us to be familiar with what types of recovery we can push, and which sports injuries require greater downtime. Sometimes a simple injury can become a long-term issue requiring extensive care or surgery if the initial recovery is rushed.”

Dietrich points to hamstring tears a good example of injuries that are prone to added problems. The hamstring is made up of three muscles. The more times one of those muscles is injured, the more likely weak scar tissue and adhesions will develop at the injured site. Scar tissue replaces the original muscle tissue, permanently altering the strength and flexibility of the injured muscle.

Trauma to the head that results in a concussion is nothing to be taken lightly either, says Dietrich. Returning to sports or activity too soon after a concussion can be extremely dangerous. If the athlete gets hurt again before allowing enough time to heal, the effects can be cumulative, risking permanent brain damage.

Research from the National Institute of Neurological Disorders and Stroke has suggested that once a person has had a concussion, he or she is as much as four times more likely to sustain a second one. After several concussions, it takes less injury to cause another concussion and recovery takes longer.

 

When It’s Safe to Return

A main concern is when an injured athlete can return to play. The decision isn’t always easy because each athlete and each injury is unique. The decision to re-engage in activity should be a collaborative one between the attending physician, athletic trainer, physical therapist, coach, parent (if a minor is involved), and the athlete.

Frank Bourgeois, Ph.D., Director of Athletic Performance at Athlete Training and Health

“We need to ensure we’re explaining to athletes the risks of continued activity or returning to sports too soon, and the potential for re-injury and an even longer downtime,” says Frank Bourgeois, Ph.D., director of Athletic Performance at Athlete Training and Health in Arlington. “I tell the athletes I work with to be patient, that there will be good days and not-so-good days throughout the recovery process. When we stick to the guidelines and collectively follow the appropriate treatment plan for the individual athlete, we can facilitate their best transitioning back to activity at the appropriate time.”

Bourgeois also talks about the psychology of returning to play, saying it is an interesting phenomenon in which an individual may be “ready to go” based on objective and subjective assessments, but now lacks confidence in game-day situations. “When the athlete passes all of the physical performance tests in the more controlled environment, what tends to happen is confidence builds until they go back to the pace of the sport itself. A bit of a mental collapse can occur. It’s my goal to safely put the athlete in sports-ready mode both physically and mentally before they actually return to their sport. Generally, the stronger an individual is before the injury, the quicker they may return to play.”

 

Guidelines for Play, Re-Injury Prevention

Dietrich offers the following guidelines for safe return to play as established by the American Orthopedic Society for Sports Medicine (AOSSM), and notes that they can allow all parties to be on the same page in the process of rehabilitation. These are guidelines only, and Dietrich advises that it is up to the health care team to make the final determination of when to release a patient for play.

  • Movement is pain-free. If something still hurts, don’t use it.
  • For lower-body injuries, bearing full weight on an injured hip, knee or ankle without limping. If you are limping, you are still not ready to return to sports. An altered gait can lead to further pain and problems.
  • For upper-body injuries, executing a throwing movement with proper form and no pain.
  • No swelling. Swelling is a sign of inflammation, so any evidence of it means it’s too early to return to sports.
  • Full range of motion. Compare the injured part with its uninjured part on the opposite side of the body to see if you have regained range of motion.
  • Strength is full or close to 90 percent. Again, compare with the uninjured side to see if strength is similar.

“The emphasis in these guidelines is on load tolerance and fatigue resistance,” Dietrich explains. “Keep in mind that even when you feel 100 percent, your strength, joint stability, flexibility or skill may be lagging. Plan to work back in to full sports and exercise goals gradually, and consult with your physician if any problem persists.”

 

The AOSSM offers sport-specific injury prevention tips for youth athletes here. To learn more about the risks of returning to play too early, visit TexasHealth.org/SportsMedicine. To find an orthopedic surgeon or sports medicine specialist in your area, visit TexasHealth.org/Find-A-Physician.

Sideline Orthopedics and Sports, Texas Health Sports Medicine, and Athlete Training and Health collaborate to provide care for athletes from the moment of injury to the moment they return to play and beyond. Read more about the joint effort.

To learn more about student athlete performance training, visit Athlete Training and Health.

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