Return to Play Following Lower Extremity Injuries Regardless of the type of lower extremity injury, i.e. ACL, Hamstring strain or Meniscal repair, return to play (RTP) remains a largely subjective decision. This article summarizes four test situations that are utilized within the Athercare Fitness & Rehabilitation clinic to evaluate RTP readiness for the athlete. Author: Donald A. Chu PhD, PT, ATC, CSCS*D, NSCA‐CPT*D, FNSCA These five (5) tests are simple to administrate, require a minimum of equipment yet will provide useful information on whether an athlete is ready to return to running, agility work and eventually play. Dynamic Knee Range of Motion: The familiar running drill of “butt kickers” is an excellent means of discerning whether the individual has dynamic range of motion in the knee equal to the normal leg. Watching the height or level of heel recovery in both legs over a distance of 10m will allow the coach to see if full range is available (Fig. 1.1, 1.2). If the heel lags on one side, the leg will form a longer lever and move slower than the normal leg during the recovery phase of running. This will cause an abnormal gait likely to lead to further injury (Fig. 1.3). Fig 1.1 Fig 1.2 Fig. 1.3 Athercare Article – Return to Play Following Lower Extremity Injuries
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Single Leg Squat: Squatting through the full range of knee flexion will allow the coach to observe weakness and lack of control. Stand with the heel on the edge of a surface high enough to allow the athlete to perform a full single leg squat (Fig 2.1, 2.2). Our standard is 6 repetitions on each leg while maintaining the knee in alignment with the second toe of the foot from both a frontal and side view (Fig. 2.3). Both sides are tested and it is felt that all athletes should be able to move their body weight through this full range. Fig. 2.1 Fig 2.2 Fig. 2.3 Bulgarian Squat Jump: Utilize the standard Bulgarian Squat position. The back foot is placed on an 18” box and the front knee is placed in a 90° position with the foot under the knee (Fig. 3.1). The athlete must push off of the front foot and jump vertically and cycle the heel so that it comes as close to the hip as possible. The athlete must then release the leg and land in the same position. Repeat for 6 repetitions. This will allow the coach to evaluate the stability and balance in the limb in question. Fig. 3.1 Athercare Article – Return to Play Following Lower Extremity Injuries
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Endurance Leg Press: A standard leg press or shuttle can be used for this test. Utilize a single leg press activity for 3 sets of 12 reps on the uninvolved leg with 30 seconds of recovery(Fig. 4.1). Note the quality of movement and signs of fatigue. If tremor or instability occurs, note the number of reps at which these signs appear, if they do. Now test the involved extremity and look for the same signs of instability and fatigue. There should be no difference as compared to the uninvolved extremity. The intensity of the exercise should be pre‐determined from past experience and training history. Fig 4.1 60 Second Box Test: You will need a box that is 12” high, 20” wide and 30” deep. The athlete starts on one side of the box (Fig 5.1) and on the “Go” command proceeds to jumps onto the box (Fig. 5.2), landing softly on the top and then jump off to the other side (Fig 5.3). They will proceed to jump on and off the box moving side to side for 60 seconds. The goal is to reach 60 counts (each time they land on top of the box) in 60 seconds. This doesn’t test their anaerobic threshold but will allow the coach to assess their power/endurance. Fig. 5.1 Fig 5.2 Fig 5.3 These five (5) tests are utilized to evaluate an athlete’s ability to return to PLAY; not just return to running. The stresses an athlete is going to be exposed to on return to the playing field are going to be high demands and success can only be achieved through assurances the athlete can endure same. Athercare Article – Return to Play Following Lower Extremity Injuries
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References: Chu, D.A. (1998). Jumping into Plyometrics. Human Kinetics, Champaign, Illinois. Harner, C., Irrgang, R., & Jorietz, R. Returning to Sport, JBJS‐JOSPT special report: It Takes a Team, March 2013 (pp. 24‐28) Bio: Donald Chu is currently the Director of the Athercare Fitness and Rehabilitation Clinic in Castro Valley, California. He serves as adjunct faculty to the Ohlone College Physical Therapist Assistant program in Newark, California. Currently, he is a member of the California Board of Physical Therapy. He is a past President of the NSCA and has served on the Board of Directors of the NATA. He is a member of the Hall of Fame for the National Athletic Trainer’s Association, Strength and Conditioning Coaches and California State University, Hayward Athletic Hall of Fame Athercare Article – Return to Play Following Lower Extremity Injuries
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