The Art of Returning to Sport after Injury

Here at Barefoot, a lot of our clients present to us with an injury they sustained during sport. From football to cricket to gridiron, there is nothing more frustrating than having an injury prevent you from playing the sport you love.

Many questions are commonly asked such as:

How long until I can get back to running?

How long until I can compete again/re-join my team?

If I play will I re-injure this again?

There are some injuries with healing timeframes which dictate roughly the minimum amount of time an athlete will spend on the sidelines. For example a bone fracture or a complete rupture of a muscle or ligament will have very specific timeframes (and possibly surgical involvement) which will prevent someone from returning to sport within those first couple weeks…

Over the next few paragraphs I want to discuss sporting injuries, and the approach we take to them at Barefoot. I will walk you through how we determine if an athlete is ready to return to sport.

The most frequent types of injuries we see in clinic are ligament, muscular and tendon soft tissue injuries – of varying degrees.

The steps we take at Barefoot when aiming to get someone back on the field (After acute management has been given):

  1. First and foremost – we need the athlete to have no neural irritation. An athlete with neural irritation stemming from the spine will not recover as fast as one who is neural clear. When nerves are irritated (as shown objectively on our Neural Dynamic Tests) the muscles around them guard/spasm to protect the nerve. This reduces movement and places higher forces on joints/structures in the body, takes the body longer to recover and if not cleared fully predisposes them to further injury. This is a crucial step.Barefoot nerve testing
  2. Appropriate Ranges of Motion (Ideally throughout the entire body – and definitely equal on both sides of the body). By going through the Barefoot Plan, we will determine areas of the body contributing to reduced ranges of motion, and treat those accordingly until an athlete has full range.
  3. Full Strength and Proprioception about the affected joints – To regain strength and balance, steps 1 and 2 need to have been addressed. The actual strength gains itself will be developed through a therapeutic, sport specific graded exercise program prescribed by one of Barefoot’s Physios or one of the trainers who we commonly refer to.
    • By this point in an athletes rehabilitation, pain should be substantially diminishing, if not completely gone
  4. Once steps 1-3 have been accomplished, it is now time to think about actually getting this athlete back to their sport. This is done by starting with the most basic principles of their sport, and working our way up to the most complex/challenging aspects of the sport. To truly be able to determine if someone is ready to return to 100% intensity of their sport, I want to recreate their sport specific environment, and assess their performance
    • If the client has any pain, discomfort, imbalance or poor motor patterns during my assessment of their abilities…then they are surely not ready to SAFELY return to sport at this time. See below example for return to sport for a soccer player 

For example, assessing a soccer player’s ability to return to sport would involve: 

  1. Running (straight line – slow pace, no change in speed no change in direction
  2. Running (straight line – medium pace, no change in speed no change in direction)
  3. Running (straight line – fast pace, no change in speed no change in direction)
  4. Running (Zig-zag between pylons – slow pace, no change in speed)
    • Repeat at moderate to fast speeds
  5. Running (jogging backwards, then turning and running in the same direction forwards – slow pace)
    • Repeat at moderate and full speeds
  6. Soccer ball skills
    • Passing a soccer ball short distance (5 feet) – inside of the foot
      • X10
    • Repeat at moderate and long distances
    • Repeat all of step 6 with a top of the foot pass
    • Repeat all of step 6 with right and left foot
  • Dribbling the soccer ball
    • Slow pace
    • Moderate pace
    • Fast pace
      • All of the above performed in a straight line, and in varying pylon set ups (zig zags)
  1. Incorporate an unstable environment:
    • Steps 1-5 re-performed without the athlete knowing which way they are going to run
      • Example:
        • Athlete running at a moderate pace towards me, at the last second I point to either my right or left and the player has to sprint for 3 seconds in that direction
  1. Combination of steps 1-5 with steps 6 and 7
    • Incorporating running with ball control
    • Example:
      • Athlete jogging, not knowing when I am going to pass him/her the ball, and when I do, having him/her pass it back to me immediately with one touch
    • This can be incredibly variable, and will start slow and steady and progress to full speed drills in an unstable environment, where the athlete has to change their speed, change their direction and perform sport specific (soccer ball) skills, all on one drill.

Physio soccer

The above is done in such an order (most basic drills to the most challenging) because I want to know immediately if there are any concerns with the athletes’ injury recovery. Unless all of the above can be performed with no concerns, then I would not be happy to tell somebody that they are ready to return to sport.

The above example is a fairly basic one. In real life, all return to sport assessments are tailored to the individuals sport and their specific position/role in the sport.

Here are Barefoot, the athletes safety and recovery is of the utmost importance, and we are here to support you. As part of your support system, it is our job to take you through the above steps, and make sure you are FULLY RECOVERED before we give you our OKAY to head back out on the field – there is nothing worse than being told you are recovered, and going out and re-injuring yourself.

If you have any sport specific questions about rehabilitation, please do not hesitate to ask 🙂

Happy sporting!

Ben Murphy soccer