[5 of 6] Return To Play For The New Age Sports & Private Practice Healthcare Professional

Welcome to part 5 of 6 In Preparation For The Launch Of My New Free Mini Course ‘The New Age Sports & Private Practice Healthcare Professional ‘which is out early January, 2017…

Part 5 of 6 Pillars of the New age Sports and private practice healthcare professional series

In this blog, you will discover how to do what even most professional sports physios can’t do at times…successfully return an athlete to the field of play without the injury reoccurring.

If you haven’t read the other posts in this series yet you can catch up here: Blog 1 on The 5 Pillars Overview, click here, Blog 2, The Subjective Assessment, click here, Blog 3, The Objective Assessment, click here or Blog 4, The Interventions, click here.

So let's get started...

The Return To Play Overview

The New Age Sports & Healthcare Professional Return To Play system is essentially just a continuum from the treatment pillar.

Too often I see a major disconnect between the treatment administered and the rehabilitation exercises given.

For the New Age Sports Pro, the athlete will receive a stimulus in the Intervention pillar and the return to play pillar will continue to expose this athlete to this load through a graded exposure manner.


It is simply not good enough to load the tissues through a graded exposure in one plane of motion as appears to be the norm now a days.

As the athlete returns to the higher end running progressions and change of direction drills, the tissues will be required to lengthen in both the transverse and frontal planes also.

Therefore the New Age Sports Pro understands this and sets about with a logical step by step progression to get the athlete to the point where the change of direction work is the next logical step.

With that said, there are THREE main areas that need to be addressed in the return to play pillar:

  1. Low Load Reassurance In Specific Directions
  2. Meaningful Movements To Previous Stressors
  3. Meaningful Movements To The Individual's Environment

Low Load Reassurance In Specific Directions

The low load reassurance stimulus will continue from the stimulus administrated via the hands on treatment if any. It will be the logical next step progression of loading of these tissues in directions that the objective assessment identified as potential stressors.

This facet will mainly be focused on during the acute stage and towards the mid level of the return to play system.

It should have a nice logical step by step approach in a graded exposure manner.

Such exercises as low load isometrics are great variations to allow a stimulus to be placed upon an athletes tissues in a specific direction under controlled conditions. It is imperative however that the loads are then progressed to more meaningful movements to allow the body an opportunity to self-organise under such loads.


Meaningful Movements To Previous Stressors

From an early stage in the injury management, the 80/20 rule is at play where 80% of the focus is spent on the previous stressors that were thought to influence the body to behave like the present situation in the first place (if non-contact).

The job of the therapist is to further undo the common reactions mentioned here and do this in a graded manner.

This facet will be vital in order to ensure that once the athlete does return to high end running and change of direction for example, that the initial perceived threats are still not present.

If a calf muscle, for example, tightened due to protective tone and was addressed using the previous facet yet the athlete returned to high level running, has the true reason the calf tightened been addressed in the first place?

Will the gastrocnemius continue to bear the brunt for the inability to cope with forces in another direction or will the body further self organise to direct forces elsewhere in the body (to the inner thigh and groin perhaps?)

Just food for some thought...

Is the calf issue simply a reaction to previous reactions and a way for the body to cope with the demands placed upon it?

Most tissues will settle with time and loading again but what happens when the loads are higher again? Has the original 'perceived threat' been addressed that caused a noxious stimulus to the calf and ultimately either protective tone or actual tissue damage?

This facet is also progressed in a graded manner throughout the return to play pillar with a sense of common sense rules covered in The ProSport Academy 12 Month Therapist Mentorship.


Meaningful Movements To The Individual's Environment

The New Age Sports & Private Practice Healthcare Professional must be crystal clear on where the athlete needs to get back to and go about putting together a step by step plan from day one.

Once the athlete is off the treatment table, every stimulus and exercise is geared with the focus of returning the athlete back to this environment with 'thoughtless, fearless, movement'.

For example, the New Age Sports Pro understands the graded exposure necessary to ensure that when an athlete is ready to run, they have earned the right to get to this point and not just because some magical time period has elapsed.

To many athletes are allowed to return to running progressions without earning the right to get there and from experience the nervous system does not react well to sudden spikes in load.

Therefore, from day 1, there is a step by step progression, based on common sense progressions tailored to the athletes needs and requirements to be successful in their environment while also being successful managing and directing forces around their body via the other two facets.

(While you are here, feel free to download my Free Ebook, 7 Steps To Clinical Excellence below where I talk about this in a lot more depth...)


Thoughtless, Fearless, Movement...

The ultimate goal is 'thoughtless, fearless, movement' and mentioned in previous pillars and from experience, this can only happen with a logical step by step progression based on the individual's needs.

The reality of the situation is that we are all under pressure to get athletes back as quickly and safely as possible and having a step by step return to play system allows you to 'control the chaos' and do your best as a healthcare professional to prepare the athlete to not only get back successful but thrive when they return.


Wrap Up

The reality of the situation is that as therapists, we have a lot to cover in a very short space of time to prepare an athlete to return in the professional sporting setting.

The ability to have a progressive return to play system that addresses both local issues, previous stressors and stresses the whole organism to the demands that will be placed upon it in meaningful ways allows some control in the chaos that is sports injuries rehabilitation.

The ProSport Academy 12 Month Therapist Mentorship does not like to put all our eggs into one basket and we see the value of hands on treatment very much if integrated with the pain science and non-manual therapy techniques and from there go about ensuring that our return to play system keeps the changes. This helps avoid the athlete becoming reliant on hands on treatment from clinical experience and ensures that when they go back, they stay back.

If you have a strong refined system, then 'niggles' and 'tightness' don't tend to hang around so you don't get athletes over reliant on hands on treatment from my own experience.

Use hands on treatment or some random exercises on tissues that are simply reacting to other stressors anyways and sure, the symptoms may return and the athlete may come looking for more reflexive changes in the forms of hands on treatment.

Using hands on treatment and a return to play system that compliments this in a responsible but most importantly clinically reasoned manner is of great value to the sports healthcare professional and compliments the other methods seamlessly when used as part of a bigger system.

Next week, we are going to look in more detail at the resilience/robustness pillar and ensuring that the athlete does not return to the treatment room with the same injury or some other 'niggle' after returning.

You can join me live on Tuesday 20th of December at 5pm GMT, for the Live teaching of Pillar 5 on The ProSport Academy Facebook Live Page Here.

So now, let me know your thoughts in the comments section below on the approach you currently use in your return to play pillar (remember, there is no right or wrong here 🙂 )...

Thank you for reading

Dave O ‘ Sullivan

P.S See you next Tuesday, 5PM GMT UK time HERE.

P.S If you haven't picked up your free copy of my free ebook The Successful Discharge Blueprint below, click on the button and I’ll get it straight to you so you can start learning more about this way of looking at the body, which I’ve used in professional sport and private practice consistently over the last nine years…