RESEARCH IN PRACTICE

QUANTIFYING RETURN TO PLAY, WHEN IS TOO SOON?

An athlete’s readiness for return to competitive activity following injury is a decision made by the sports medicine practitioner using his/her experience and knowledge, as well as the athlete’s ability to meet return to sport criteria. However few health professionals could say that they are 100% confident that an athlete has recovered sufficiently to meet the demands of their chosen sport. In elite competitive sport a number of other extrinsic factors such a commercial inter- ests place increasing demand on the sports medicine practitioner to make an athlete available for selection, clouding the line between early and appropriate return to participation.

Quantifying the functional rehabili- tation of injured football players C W Fuller, J Walker British Journal of Sports Medicine 2006; 40:151-157

This paper provides a new and interesting view into the issue of return to play crite-

ria in sport and highlights the moral issues faced by those working in sports medicine, particularly those working within the team environment. The authors propose a novel model to quantify match readiness based upon pre-injury objective markers as a measure of recovery. This is with the aim of providing an exit point to rehabilitation which is transparent to all, including mem- bers of the medical and management team alike.

This model was implemented at a profes- sional football club to monitor player’s recovery from injury. During a period of two seasons, 118 injuries occurred within a pool of 55 players, equating to 24 injuries per 1000 match hours and 1.3 injuries per 1000 training hours respec- tively. During the injury process players were continually monitored over a series of tests as part of their rehabilitation. These scores were plotted as a percentage of pre- injury levels, with players considered fit to play only when they had achieved a score equal to baseline scores.

From the data a number of benchmark functional rehabilitation curves for com- mon injuries eg. thigh muscle strain were produced to demonstrate the amount of time a player spent in rehabilitation. Recovery curves were also plotted which enable a player’s rehabilitation to be reviewed at any stage of recovery process, such curves also allow the success of dif- ferent rehabilitation strategies to be assessed, to determine best practice.

This model has clear merits and provides therapists working in the field of sports medicine with food for thought and an opportunity to reflect on their own current return to play protocols. The authors should be commended on providing a model which is both practical and could be implemented with relative ease. However it is the responsibility of the sports medi- cine practitioner to continually develop their own protocols and outcome measures to ensure pre-injury status is met prior to return to sport. Perhaps the answer to establishing baseline measures of pre-

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