1. adverse effects of the injury on the structures involved; e.g., ligaments, muscles, tendons, bone;
2. the effect of the injury on the athlete's strength, endurance, flexibility, and agility;
3. the effect of the period of inactivity on the athlete's cardiovascular fitness;
4. the effect of the injury and/or inactivity on the athlete's sport-specific skills; and
5. the athlete's psychological response to the injury.

Readiness to Compete

The primary information necessary for determining the extent of an injured athlete's readiness to resume competitive sports may be found in the athlete's preseason test results on strength, cardiovascular fitness, flexibility, and sport-specific performance.

Each sport has different preseason physical and performance requirements that an athlete must meet in order to participate successfully. For example, swimmers need to be tested for range of motion and muscular endurance of the shoulder muscles before the season begins in earnest. Adequate shoulder flexibility and endurance are required for optimal performance and for reducing injury occurrence and severity. On the other hand, football linemen should be tested on total body muscular power and strength before beginning strenuous football practice.

Whenever an injury occurs, comparisons with preseason assessments may be the only way a coach, athletic trainer, or physician can determine the athlete's degree of readiness for returning to competition. Furthermore, by utilizing the athlete's preseason results as a standard, the athlete's rehabilitation program can be designed to address functional and performance deficits before allowing the athlete to return to participation.

Post Injury Anxiety

An athlete's post-injury anxiety can be minimized by informing the athlete (and his/her parents) of criteria and standards used for determining the appropriate time to return to participation. Establishment of return-to-participation criteria prior to the season enables the coaching staff to use objective standards when assessing the athlete's status. This factor alone can go a long way in assisting the athlete to stay motivated and to continue to feel a part of the team. It also enables the coaches to keep abreast of the athlete's recovery on a frequent basis.

Return to Play Criteria

The return-to-play criteria may be general and/or sports specific. It is important to remember, though, that the criteria should be stated prior to the season and clearly understood and accepted by coaches, athletic directors, trainers, athletes, parents, and team physicians.

The return-to-participation criteria may be different for each type and degree of injury. For example, the criteria for a properly diagnosed minor ankle sprain (no loss of function, little or no swelling, and mild soreness rather than severe pain) might include the ability to hop in place for 30 seconds, run, jump, and perform sport-specific agility drills. In the event there is no noticeable deficit in the athlete's gait or jumping proficiency, the athlete may be permitted to return to participation.

In the case of a severe ankle sprain diagnosis, the athlete must satisfy additional criteria before being permitted to participate. The athlete may have to demonstrate that the injury no longer affects cardiovascular endurance, bilateral leg/ankle strength, range of motion and stability, and competitive confidence.

Informing the athlete of the return-to-participation process should be done early on so that the athlete can become a full partner in the rehabilitation process. This will alleviate the chances of the athlete feeling excluded from the team, and may be especially important in avoiding an atmosphere that may affect the athlete's relationship with teammates.

Summary

Objective criteria should be used as guidelines for assessing an athlete's readiness to return to participation after injury. Preseason functional test data should be used as a standard of comparison for post-injury rehabilitation. Other criteria may be sport specific and depend on the nature of the injury. Finally, to the greatest extent possible, return-to-participation guidelines should be stated at the beginning of the season, and accepted by the athletes, parents, coaches, athletic trainers, and team physicians.