Return to Play -- A Coach's Guide - American College of Sports ...

ACSM Information On…Return to Play – A Coach’s GuideInjuries are a common occurrence for those who exercise. Whether it is tendinitis or an acute traumatic injury, many injuries require restrictionof and/or change in your exercise program. The amount of time away from exercise varies according to the type of injury, severity of injury,body part involved and other situational factors. Depending on the type and severity of the injury, you may experience pain, swelling, stiffness,weakness or decreased range of motion.A COMPLETE PHYSICAL ACTIVITY PROGRAMA well-rounded physical activity program includesaerobic exercise and strength training exercise, butnot necessarily in the same session. This blend helpsmaintain or improve cardiorespiratory and muscularfitness and overall health and function. Regularphysical activity will provide more health benefits thansporadic, high intensity workouts, so chooseexercises you are likely to enjoy and that you canincorporate into your schedule.ACSM’s physical activity recommendations for healthyadults, updated in 2011, recommend at least 30minutes of moderate-intensity physical activity(working hard enough to break a sweat, but still ableto carry on a conversation) five days per week, or 20minutes of more vigorous activity three days perweek. Combinations of moderate- and vigorousintensityactivity can be performed to meet thisrecommendation.Examples of typical aerobic exercises are:• Walking• Running• Stair climbing• Cycling• Rowing• Cross country skiing• Swimming.In addition, strength training should be performed aminimum of two days each week, with 8-12repetitions of 8-10 different exercises that target allmajor muscle groups. This type of training can beaccomplished using body weight, resistance bands,free weights, medicine balls or weight machines.CONTROLLING THE INITIALSYMPTOMS (PRICE)• Protect: Protect the affected area fromfurther injury.• Rest: Rest and protect the injured part atfirst to experience less swelling and amore rapid recovery.• Ice: Put ice on the affected area todecrease swelling and help control pain.This is especially helpful in the first 48 to72 hours after injury.• Compression: Wrap or brace the injuredpart to allow for control of initial swellingand to decrease motion.• Elevation: Elevate the injured part,especially if it is kept above the heart, asthis helps decrease swelling and pain.HEALING TIMEHealing time depends on site, severity andtype of injury. For example, a mild anklesprain may heal in two to four weeks,while a fracture of the leg may take eightto 12 weeks. However, healing usuallyproceeds in certain stages.• Swelling and pain decreases ordisappears in the first 24 to 72 hours.• Discoloration and bruising usuallysubsides within ten to 14 days.• Range of motion increases over seven to14 days, though stiffness and weaknessmay persist.When an injury occurs, it may result inweakness, due to tissue damage anddisuse, and decreased control over thedamaged body part. Regaining strengthand coordination of the injured body partshould be considered part of therehabilitation and healing process.Attempting to return to an activity beforeproper healing of the injury puts you atrisk to reinjure yourself.

GUIDELINES FOR RETURN TOPLAYYou should have pain-free full range ofmotion. The injured body part should havefull movement and flexibility with little orno discomfort.• Return of strength: The injured bodypart should be approximately equal (90-95 percent) to the opposite side beforereturning to full activity.• Minimal pain or swelling: Some milddiscomfort, stiffness and/or swellingduring or after exercise is to be expectedduring the initial return to activity. Ice canbe used to alleviate these symptoms.• Functional retraining: You should beable to effectively perform the specificmotions and actions required for yoursport before returning to activity. Forexample, retraining a lower-extremityinjury in basketball should involve theability to run, stop, change directionsand jump.• Progressive return to activity:Consider starting at 50 percent ofnormal activity and progress astolerable. An informal guideline you canuse is to progress activity 10-15 percentper week if the previous level of activitydoes not result in increased symptomsduring exercise or the day after exercise.• Continue general conditioning withcross-training: Doing an alternativeexercise allows maintenance of generalcardiovascular fitness while notinterfering with the healing of an injury.For example, ankle and knee injuriesmay do well with bicycling or swimming.• Mental confidence in ability to doexercise: You must feel that you andyour injury are ready to perform at thelevel required for your particular activity.If you have any questions about how theabove guidelines apply to your particularinjury, please consult with a sportsmedicine professional.STAYING ACTIVE PAYS OFF!Those who are physically active tend to live longer,healthier lives. Research shows that moderatephysical activity – such as 30 minutes a day of briskwalking – significantly contributes to longevity. Even aperson with risk factors like high blood pressure,diabetes or even a smoking habit can gain realbenefits from incorporating regular physical activityinto their daily life.As many dieters have found, exercise can help youstay on a diet and lose weight. What’s more – regularexercise can help lower blood pressure, control bloodsugar, improve cholesterol levels and build stronger,denser bones.THE FIRST STEPBefore you begin an exercise program, take a fitnesstest, or substantially increase your level of activity,make sure to answer the following questions. Thisphysical activity readiness questionnaire (PAR-Q) willhelp determine if you’re ready to begin an exerciseroutine or program.• Has your doctor ever said that you have a heartcondition or that you should participate in physicalactivity only as recommended by a doctor?• Do you feel pain in your chest during physicalactivity?• In the past month, have you had chest pain whenyou were not doing physical activity?• Do you lose your balance from dizziness? Do youever lose consciousness?• Do you have a bone or joint problem that could bemade worse by a change in your physical activity?• Is your doctor currently prescribing drugs for yourblood pressure or a heart condition?• Do you know of any reason you should notparticipate in physical activity?If you answered yes to one or more questions, if youare over 40 years of age and have recently beeninactive, or if you are concerned about your health,consult a physician before taking a fitness test orsubstantially increasing your physical activity. If youanswered no to each question, then it’s likely that youcan safely begin exercising.PRIOR TO EXERCISEPrior to beginning any exercise program, including theactivities depicted in this brochure, individuals shouldseek medical evaluation and clearance to engage inactivity. Not all exercise programs are suitable foreveryone, and some programs may result in injury.Activities should be carried out at a pace that iscomfortable for the user. Users should discontinueparticipation in any exercise activity that causes painor discomfort. In such event, medical consultationshould be immediately obtained.ACSM grants permission to reproduce this brochure if it is reproduced in its entirety without alteration. The text may be reproduced in another publication if it is used in its entiretywithout alteration and the following statement is added: Reprinted with permission of the American College of Sports Medicine. Copyright © 2011 American College of SportsMedicine. This brochure was created and updated by Lawrence M. Magee, M.D., FACSM, and is a product of the American College of Sports Medicine. Visit ACSM online atwww.acsm.org.