By Stacey Hardin PT DPT ATC
When a player sustains an injury, the desire to spring into action is strong. While immediate intervention can positively impact return to performance and jumpstart the rehab process, it is equally as important to devote time to planning and structuring a collaborative approach. This plan is meant to provide a general roadmap for all parties. Members of the performance team will then develop details specific to their area of expertise and have greater confidence that they’ll be aligned with their colleagues.
For the purpose of this article, the performance staff includes a physical therapist, athletic trainer, dietician, strength and conditioning specialist, sports scientist, video analyst and assistant coach. Members, and more importantly their skill sets and responsibilities, will vary based on your setting and individual system. Let’s explore the basics:
1. Needs Analysis
2. Goals and Expectations
3. General Timeline
4. Specific Logistical Planning
Needs Analysis
In order to successfully return an athlete to performance, we must first understand what he or she needs to do. Well, obviously, they need to be able to play soccer! Run, jump, change direction, strike a ball...But what does this particular athlete need to be able to do? What are the demands when, where and how he plays? Although both are midfield players, a central midfielder is going to have very different demands than a winger. Even within one specific player, he may have different demands depending on any number of tactical factors or natural game to game variation. Understanding the coach and Club’s basic playing style and identity is helpful to identify situations the player will likely find himself in and therefore, will need to be prepared for.
This is a great opportunity to revisit any pre-injury metrics you may have. Without any additional technology or resources, you can start as simple as the number of training sessions per week and an estimation of duration of each session. If you have access to information such as match and training GPS data, video clips, heart rate data, previous wellness questionnaires, force plate measurements, and strength or movement assessments, pull those together too. The clearer picture you are able to have about what the player must be prepared to do and his or her capabilities prior to the injury, the greater chance you have to match the two.
In its basic form, injury results because of a mismatch between the organism, the task and the environment. Many people say, “I don’t want to return a player just back to where she was before the injury because she got hurt, so where she was wasn’t good enough.” This may be true. Leaning into your post-injury critical review will help identify which factors deserve greater attention. The post-injury critical review was derived from morbidity and mortality (M&M) meetings that hospitals complete. M&M meetings are conducted following an adverse event, including death. In the case of an athlete, the adverse event is typically an orthopedic injury. The goal of this review is to increase the quality of services provided (medical care, fitness plans, nutritional interventions, etc) by systematically identifying areas of improvement and promoting education and learning without the fear of embarrassment, blame or punishment. Injury-risk is multifactorial; however, there is an ever-growing body of sport-specific literature to help identify relevant factors to your population which can help refine your post-injury critical review process.
Goals and Expectations
Most people assume an athletes’ #1 goal is to return to play as quickly as possible; however, asking the simple question and then listening can shed light on many unexpected areas. What are your goals? Perhaps this player is a novice and her goal is to learn as much about her ankle and body as she can. Maybe he is in the last month of his professional contract before retirement and wants to be able to play tag with his young daughters. In addition to returning to performance, goals may involve activities in their daily life like being able to sit in class or watch a movie without constantly repositioning due to low back pain. Amongst other things, these goals help to provide direction and accountability, set a standard of communication and collaboration, and give the athlete an opportunity to have a personal, vested interest in the process and outcome. Asking this basic question can be helpful in treating the person in front of you, not just the soccer player.
What are your expectations? During this stage, an athlete will be able to share his or her ideas surrounding the return to performance process. This may be influenced by a number of different factors including experiences with different Clubs or providers, social media, teammates and family anecdotes or beliefs. It also provides an opportunity for the performance team to share their expectations and standards as well. You may learn that a player expects to receive manual therapy daily. Or maybe this is a veteran player who would prefer getting into the gym at 6:00am every day to finish before other teammates arrive. Ironing out any discrepancies ahead of time can prevent future headaches and further cement the performance team’s commitment to the player’s recovery.
General Timeline
When am I going to be able to play again? Is one of the most common questions any athlete has after sustaining an injury. A structured rehab plan should include anticipated return to participation (able to rejoin some training), return to sport (full, unrestricted training and match availability) and return to performance (meeting or eclipsing pre-injury performance status). It should also outline when other general functional goals can be expected to be met. Thought should be given to physiological healing times of the injured structure(s) as well as criteria-based progressions. Understandably, many performance professionals are apprehensive to attach timelines to the recovery process; however, sharing the thought process and expected progression can help those involved understand the non-rigid nature of recovery.
Specific Logistical Planning
Depending on your resources, specific logistical planning may prove to be one of the most challenging, yet valuable tasks. Some organizations have enough manpower, space and other resources to structure this process exactly as desired; however, this is rarely the case. The additional responsibilities of those who will be part of the return to performance process need to be identified and accounted for during planning. Often players are required to report outside of traditional team hours to ensure access to as many performance members as needed. Team travel may leave little to no resources in-market and necessitating outside referral for a period of time. Depending on the time of the season, full team training might not provide all of the work the player needs and will need to be supplemented. Attention should also be paid to ensure an appropriate level of physical and mental rest are offered.
You don’t need any fancy equipment or technology for this task. Excel, google calendar and Outlook all work great, or consider integrating into whatever system your department or Club already uses to help with scheduling and coordination. Simply, this process will help ensure the things you are capable of planning for and anticipated conflicts have been addressed.
How do you tackle return to performance? What are your thoughts? I’d love to hear- feel free to comment below or email: stacey.hardin@gmail.com.
Best,
Stacey