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REHABILITATION AN APPROACH TO SCREENING THE

RECOVERING ATHLETE

Sport and exercise plays an important role in our lives. There are very few reading this article who are not affected by sport or exercise on a regular basis, either as participants, clinicians, observers or all of these. Sports medicine plays an important role in all areas of sport and exer- cise, from the prevention of injury, through to early post injury man- agement, rehabilitation and finally to coordinating return to sport.

This final stage, the return to sport, is often the most difficult in sports medicine. It is where our decisions on patient management are most under the scrutiny of others. Managers, coaches, the player, the team and spectators are all dependent on our decision. While patient safety should always remain the cornerstone of our decision making process, when faced with mounting pressure to make a professional decision on the ability of an athlete to return to sport, it is important that the decision is based on sound scientific principles.

This article reviews the available evidence in the area of pre-partici- pation assessment of the recovering athlete.

By Steve Milanese, MAPA, MMPAA, MCSP, MESA

INTRODUCTION In practice the screening process is often left up to the phys- iotherapist and the doctor with encouragement and ‘advice’ from other interested parties. In clinical practice we screen our patients on a treatment by treatment basis. We make decisions on how much exercise they can tolerate in their exercise programmes, what treatment is appropriate, how much treatment is appropriate etc. based on our clinical rea- soning process. In the occupational arena we may use ‘func- tional capacity assessments’ to help us to ascertain a work- er’s capacity to safely return to work. In the sports medicine model our decision is based on our understanding of our patient’s (ie. the athlete) clinical presentation and our understanding of the physical demands of the sport.

Any pre-participation screening process seeks to identify a person’s capacity and then uses this information to deter- mine the ‘physical capacity versus physical demands’ equa- tion. When physical capacity (ie. of the athlete) is greater than the physical demands (ie. of the sport) then the athlete is safe to return to the sport. When physical capacity is less than the physical demands, then the rehabilitation process is incomplete.

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EVIDENCE FOR THE PRE-PARTICIPATION SCREENING OF ATHLETES Taylor (1) reviewed the evidence for the screening of athletes to pre- dict sporting injury. An updated literature search was used to ensure current evidence for this review. Forty two articles published between the years 1970 to 1998, were reviewed, the majority being published since the late 1980s suggesting increasing interest in the area. Taylor broadly divided the types of studies into three main categories: those articles describing the general screening examination of the athlete (20 studies), those describing the screening of a particular body seg- ment (15 studies), and those describing the screening of athletes for specific sports (seven studies). Twenty four of the studies were of experimental design with the rest of non-experimental design.

Of the general screening articles seven of the 20 (35%) were cohort, case control series and cross sectional survey design studies, which are the best study designs in which to measure risk and predictability. The sport specific screening articles contained five out of seven (71%) of such designs and the screening for a particular part of the body arti- cles 12 out of 15 (80%).

Risk is the likelihood that a person without an injury, subject to cer- tain risk factors, will develop an injury (2). Predictability is the quan- tification of the risk, allowing us to predict whether an individual is going to get an injury based on the presence of risk factors.

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