When is it Safe to Return to a Sport after an Injury?

When working in a Sports Medicine Center, this question comes up repeatedly. After all, when dealing with athletic injuries, our goal is also to return the athlete to full and competitive level function. As practitioners, we are regularly challenged to make the right decisions and recommendations, not only for competitive athletes, but also for recreational participants and the physically active. The decision to allow an athlete to return to sports should be based on sound assessment of the injury, thorough treatment and complete rehabilitation, with very minimal risk of re-injury or aggravation.

In all situations, for athletes and non-athletes alike, our primary concern and objective is to return the participant to a healthy status without jeopardizing his or her overall health in the long run. The decision on when to return to play is based on a few questions.

• First, can the athlete play safely?

This requires knowing the extent of the injury, assessing any potential worsening of the injury, and evaluating the potential for a secondary injury.

• Second, can the athlete play effectively?

Input from the athlete, the team's athletic trainer, and the coach is invaluable. If the answer to either of the above questions is "no", then the athlete is out of the game.

If the answer to these two questions is "yes", one final question remains:

• Is the athlete playing with pain?

Competing in pain is difficult and decreases the ability to play effectively, although some athletes can override their pain making the decision more difficult. If the athlete is having a lot of pain, it is likely they will not be able to compete mentally or physically and should be removed from competition.

Even after these questions are answered, the coach, in communication with the athlete, will make the decision based on the game situation, the seasonal situation, who else can play instead, and other factors.

Returning an athlete to competition is a complex decision requiring a team approach. Input from the team physician, athlete, team trainer, coach and parents helps to avoid making any poor decisions.

For further reading, look up the recent issue dedicated to Return from Sports Injury Issues in the Clinical Journal of Sport Medicine (Vol 15, number 6, Nov 2005).

Sports and physical activity should be pain-free and fun. Here at the UI Sports Medicine Center , our goal is to promote an active, healthy, balanced lifestyle for all age groups, skill levels, and levels of competition.

And remember:

Life is a Sport-Get back into it!

Ned Amendola, MD