Return to Sport After Injury

NewsBot · May 24, 2020

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A cross-cultural validation of the Attention Questionnaire of Rehabilitated Athletes Returning to competition
CristianaContiaSeleniadi FronsoaMaurizioBertolloabClaudioRobazzaa
Physical Therapy in Sport; 23 May 2020

Highlights
•Decreased attention or increased distractibility augment the risk of re-injury and sub-optimal performance.
•The AQ-RARC assesses selective attention of injured athletes returning to competition.
•Cross cultural investigations of the scale have not been previously conducted.
•Confirmatory Factor Analysis of the Italian version (AQ-RARC-IT) supported the two-factor structure.
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Objectives
To culturally adapt the Attention Questionnaire of Rehabilitated Athletes Returning to Competition (AQ-RARC) in the Italian language.

Design
Cross-sectional study.

Setting
Italian athletes.

Participants
We recruited 324 athletes (215 men, 109 women) divided in two samples: 101 injured athletes returning to their first competition following injury, 223 non-injured athletes making their first competition of the regular season.

Main outcome measures
The AQ-RARC-IT, the Psychobiosocial States Scale (PBS-ST), and a Concentration/Disruption scale. Athletes completed the questionnaires at the end of their first competition. We investigated the construct validity, the internal consistency, and the concurrent validity of all measures.

Results
A confirmatory analysis (CFA) supported the two-factor structure of the AQ-RARC-IT yielding acceptable fit indices, CFI = 0.930, TLI = 0.912, RMSEA (90% CI) = 0.100 (.076–.123), and SRMR = 0.082. Concurrent validity was evaluated through Pearson's correlation coefficients between measures. Correlations ranged in magnitude from weak to moderately high.

Conclusions
Study findings showed satisfactory psychometric properties of the AQ-RARC-IT. The questionnaire can be used for clinical and research purposes.
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NewsBot · May 24, 2020

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Time to Return to Athletic Participation Following Stress Fracture
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Return to Sport in Athletes with Achilles tendinopathy
Return to play after ankle injury

NewsBot · Jan 14, 2021

Optimizing Return to Play for Common and Controversial Foot and Ankle Sports Injuries
Sachin Allahabadi et al
JBJS Rev. 2020 Dec 18;8(12)

»: Surgical decision-making should consider factors to help optimize return to play for athletes with foot and ankle injuries, including injuries to the syndesmosis, the Achilles tendon, the fifth metatarsal, and the Lisfranc complex. Understanding influential factors on return to play may help orthopaedic surgeons counsel athletes and coaches on expectations for a timeline to return to play and performance metrics.

»: Outcomes after rigid and flexible fixation for syndesmotic injuries are generally favorable. Some data support an earlier return to sport and higher functional scores with flexible fixation, in addition to lower rates of reoperation and a decreased incidence of malreduction, particularly with deltoid repair, if indicated.

»: Minimally invasive techniques for Achilles tendon repair have been shown to have a decreased risk of wound complications. Athletes undergoing Achilles repair should expect to miss a full season of play to recover.

»: Athletes with fifth metatarsal fractures have better return-to-play outcomes with surgical management and can expect a high return-to-play rate within approximately 3 months of surgery.

»: Percutaneous treatment of Lisfranc injuries may expedite return to play relative to open procedures.
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NewsBot · Apr 25, 2021

Acute foot and ankle injuries and time return to sport
Gowreeson Thevendran et al
SICOT-J 2021, 7, 27

Foot and ankle sports injuries encompass a wide spectrum of conditions from simple contusions or sprains
that resolve within days to more severe injuries that change the trajectory of an athlete’s sporting career. If missed,
severe injuries could lead to prolonged absence from the sport and therefore a catastrophic impact on future performance. In this article, we discuss the presentation of the commonest foot and ankle sports injuries and share recent
evidence to support an accurate diagnosis and best management practice.
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NewsBot · Apr 26, 2021

Insertional Achilles Tendinopathy: analysis of 166 procedures and return to activity
Amol Saxena et al
April 20, 2021

The surgical procedure for Insertional Achilles tendinopathy (IAT) varies widely with no consensus as to approach and documenting return to activity (RTA). This study presents outcomes of surgery for IAT by a single surgeon, documenting activity level and return to activity. From January 2001 through January 2018, 166 procedures were reviewed. Surgery included debridement of the Achilles insertion, resection of the superior calcaneus and bursa, and re-attachment with suture anchors. There were 110 males and 56 females. The majority of patients in the entire cohort were runners (n = 54). The average age of the cohort was 50.3 ± 12.1 years (range 20-80). Average follow-up was 114.0 ± 63.5 months (range 6-222 months). Average RTA for males and females were 6.43 months and 7.22 months, (P=.2), respectively. There was no difference in RTA between patients who had calcific tendinosis (n = 84) and non-calcific tendinosis (n = 82). Complications were 2 infections, 2 DVTs, and 17 deep suture reactions with a total complication rate of 12.6%; there were no re-ruptures post-operatively. There was no significant difference in number of complications between absorbable and non-absorbable suture in the anchors (p = 0.41). The average RM score was 1.5 ± 0.7. The RM scores were better for males (P=.002), but there were no differences in RTA or complications between sexes. Overall, 95.8% of the procedures resulted in improved outcome and ability to return to activity including sports. This retrospective investigation shows surgical intervention for IAT yields good results with an average return to activity including sports in approximately 7 months.
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NewsBot · Aug 2, 2021

Defining Return to Sport: A Systematic Review
Joshua Doege, MS, Jack M. Ayres, BS, Matthew J. Mackay, MD, ...
Orthopaedic Journal of Sports Medicine July 26, 2021

Background:
Return to sport (RTS) commonly serves as a measure for assessment of clinical outcomes in orthopaedic sports medicine surgery. Unfortunately, while RTS is commonly utilized in research for this purpose, currently there is no widely accepted or standardized definition for when an athlete has officially returned to his or her sport.

Purpose:
To conduct a systematic review to evaluate and report the differences in specific definitions of RTS utilized in the orthopaedic surgery literature.

Study Design:
Systematic review; Level of evidence, 4.

Methods:
A systematic review was performed using PubMed, EMBASE, and Cochrane Trials databases per PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Search terms consisted of variations of “RTS” combined with variations of “orthopedic surgery” and “define” to capture as many relevant articles as possible. The definition of RTS was recorded and analyzed.

Results:
A total of 718 articles were identified in the initial search, 29 of which met eligibility criteria, providing a clear definition of RTS. Of the 29 studies included, 20 (69.0%) defined RTS as an athlete competing in a game or other competitive play. Three (10.3%) defined this as the athlete competing in a game or other competitive play but with an explicitly stated competition-level modifier of the athlete returning to his or her preinjury level of competition. Two articles (6.9%) included returning to training or practice, and the remaining 4 articles (13.8%) used terminology other than the standard RTS.

Conclusion:
There is variability in the definition of RTS used in orthopaedic sports medicine literature. Most studies refer to the athlete competing in a game or other competitive play. Other variants include returning to practice/training and explicitly defined competition levels and objectives. Future studies should aim to standardize the definition of RTS to facilitate more precise assessment of outcome after sports medicine surgery. Using terminology that describes components of the recovery and rehabilitation process, such as “return to participation” and “return to performance,” in addition to RTS will allow us to more clearly understand the athlete’s recovery and associated level of competition or performance.
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NewsBot · Jan 3, 2022

The final stage (late) of sport rehabilitation:
Critical analysis of quality of movement and
injury risk factors during return to sport
D’Onofrio Rosario et al
Ita. J. Sports Reh. Po. 2021; vol.8; Suppl.1 al n.3; 13 -30

Background. An ever increasing number of athletes incur injuries during sporting activity.
Introduction. A previous injury is often associated with a decrease in gestural quality. This is
identified as an important risk factor for second injuries which is consistent with the results of
many studies in the recent literature. Objective. The purpose of this article is to investigate the
reliability and validity of functional tests such as FMS, AAA, LESS, TJA.
Method. Our research was limited to reviewing the studies published in the last 10 years in
English on the PubMed database. Results. We found a limited literature referring to functional
tests investigating the quality of movement. This allows us to affirm, also given the subjective
analysis of the evaluations, their unreliability and validity in the diagnostic and therapeutic use
of complex sports gestures and in rehabilitation practice. There is also conflicting and
inconsistent evidence regarding the analysis of the quality of post – injury movement to
determine altered patterns and postural – dysfunctional pictures linked to specific gestures.
Conclusions. In conclusion, further research is essential to focus on the validity of subjective
evaluations, aimed at validating the quality of movement. Subjective Evaluation Tests, as such,
found in the literature should be used in conjunction with additional clinical tests and evaluations
to identify other sport-specific injury risk factors.
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NewsBot · Feb 3, 2022

Injury Prevention, Safe Training Techniques, Rehabilitation, and Return to Sport in Trail Runners
Heather K.VincentPh.D.MichaelBrownsteinM.D.Kevin R.VincentM.D., Ph.D.
Arthroscopy, Sports Medicine, and Rehabilitation
Volume 4, Issue 1, January 2022, Pages e151-e162

This current concept, narrative review provides the latest integrated evidence of the musculoskeletal injuries involved with trail running and therapeutic strategies to prevent injury and promote safe participation. Running activities that comprise any form of off-road running (trail running, orienteering, short-long distance, different terrain, and climate) are relevant to this review. Literature searches were conducted to 1) identify types and mechanisms of acute and chronic/overuse musculoskeletal injuries in trail runners, 2) injury prevention techniques most relevant to running trails, 3) safe methods of participation and rehabilitation timelines in the sport. The majority of acute and chronic trail running-related musculoskeletal injuries in trail running occur in the lower leg, primarily in the knee and ankle. More than 70% are due to overuse, and ankle sprains are the most common acute injury. Key mechanisms underlying injury and injury progression include inadequate neuromotor control-balance-coordination, running through fatigue, and abnormal kinematics on variable terrain. Complete kinetic chain prehabilitation programs consisting of dynamic flexibility, neuromotor strength and balance, and plyometrics exercise can foster stable, controlled movement on trails. Patient education about early musculoskeletal pain symptoms and training adjustment can help prevent injury from progressing to serious overuse injuries. Real-time adjustments to cadence, step length, and knee flexion on the trail may also mitigate impact-related risk for injury. After injury occurs, rehabilitation will involve similar exercise components, but it will also incorporate rest and active rest based on the type of injury. Multicomponent prehabilitation can help prevent musculoskeletal injuries in trail runners through movement control and fatigue resistance.
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NewsBot · Apr 24, 2022

A Framework for Clinicians to Improve the Decision-Making Process in Return to Sport
Kate K. Yung, Clare L. Ardern, Fabio R. Serpiello & Sam Robertson
Sports Medicine - Open volume 8, Article number: 52 (2022)

Return-to-sport (RTS) decisions are critical to clinical sports medicine and are often characterised by uncertainties, such as re-injury risk, time pressure induced by competition schedule and social stress from coaches, families and supporters. RTS decisions have implications not only for the health and performance of an athlete, but also the sports organisation. RTS decision-making is a complex process, which relies on evaluating multiple biopsychosocial factors, and is influenced by contextual factors. In this narrative review, we outline how RTS decision-making of clinicians could be evaluated from a decision analysis perspective. To begin with, the RTS decision could be explained as a sequence of steps, with a decision basis as the core component. We first elucidate the methodological considerations in gathering information from RTS tests. Second, we identify how decision-making frameworks have evolved and adapt decision-making theories to the RTS context. Third, we discuss the preferences and perspectives of the athlete, performance coach and manager. We conclude by proposing a framework for clinicians to improve the quality of RTS decisions and make recommendations for daily practice and research.
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NewsBot · Nov 17, 2022

Investigating the Effect of Return-to-Play Timing After Injury on Performance: Does the Analysis Answer the Research Objective?
Ian Shrier, Tyrel Stokes, Chinchin Wang, Jorge Trejovargas, Franco M. Impellizzeri & Russell J. Steele
Sports Medicine (2022)

Return-to-play decision making should be based on all the advantages and disadvantages of return to play for athletes, not just the risk of injury. For competitive athletes, this includes the effect of early versus delayed return to sport on performance. In this paper, we address the questions “How can I estimate the effect of injury on the individual’s performance at return to play?” and “What is the effect of delaying return to sport on the individual’s performance?”. To address these questions, we describe (1) some foundational concepts, design and analytical challenges related to estimating the causal effect of return to play timing on performance in the athlete, (2) additional challenges if one is interested in the effects of delaying return to play and (3) differences when the questions relate to the team’s performance. Although the analytical strategies described appear complicated, coaches and athletes make these judgements informally every day without explicitly stating their assumptions. Using a formal approach should help analysts provide the most valid answers to the questions asked by athletes and coaches. In brief, the choice of a comparison group depends on the research question and requires that one consider the hypothetical performance trajectory of the athlete had they never been injured. Thus, the optimal comparison group depends on the shape of the expected trajectory and the specific research question being asked.
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NewsBot · Jan 31, 2023

Return to sport following low-risk and high-risk bone stress injuries: a systematic review and meta-analysis
Tim Hoenig et al
BJSM

Objective Bone stress injuries (BSIs) are classified in clinical practice as being at low- or high-risk for complication based on the injury location. However, this dichotomous approach has not been sufficiently validated. The purpose of this systematic review was to examine the prognostic role of injury location on return-to-sport (RTS) and treatment complications after BSI of the lower extremity and pelvis.

Design Systematic review and meta-analysis.

Data sources PubMed, Web of Science, Cochrane CENTRAL and Google Scholar databases were searched from database inception to December 2021.

Eligibility criteria for selecting studies Peer-reviewed studies that reported site-specific RTS of BSIs in athletes.

Results Seventy-six studies reporting on 2974 BSIs were included. Sixteen studies compared multiple injury sites, and most of these studies (n=11) described the anatomical site of injury as being prognostic for RTS or the rate of treatment complication. Pooled data revealed the longest time to RTS for BSIs of the tarsal navicular (127 days; 95% CI 102 to 151 days) and femoral neck (107 days; 95% CI 79 to 135 days) and shortest duration of time for BSIs of the posteromedial tibial shaft (44 days, 95% CI 27 to 61 days) and fibula (56 days; 95% CI 13 to 100 days). Overall, more than 90% of athletes successfully returned to sport. Treatment complication rate was highest in BSIs of the femoral neck, tarsal navicular, anterior tibial shaft and fifth metatarsal; and lowest in the fibula, pubic bone and posteromedial tibial shaft.

Conclusion This systematic review supports that the anatomical site of BSIs influences RTS timelines and the risk of complication. BSIs of the femoral neck, anterior tibial shaft and tarsal navicular are associated with increased rates of complications and more challenging RTS.
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NewsBot · Apr 17, 2023

Is there any biomechanical justification to use hopping as a return to running test? A cross-sectional study
Jérôme Riera et al
Physical Therapy in Sport; Volume 61, May 2023, Pages 135-141

Objective
To assess the agreement and the correlation between asymmetry indexes of leg stiffness (AI(Kleg)) in running and hopping and the correlation between leg stiffness (Kleg) in running and hopping.

Design
Cross-sectional study.

Setting
Clinical facility.

Participants
Twelve healthy runners (5 women and 7 men; mean (SD) age = 36.6 (10.1) years; activity level = 6.4 (0.9) on Tegner scale).

Main outcome measures
A treadmill instrumented by photoelectric cells was used to collect data (flight and contact times) during running assessment (preferential and imposed velocity (3.33 m s−1) and during a hopping test. Kleg and AI(Kleg) were computed for each modality. Correlation tests were performed, and Bland Altman's plot was created.

Results
A significant and large correlation was found between Kleg in hopping and running at imposed speed (r = 0.6, p = 0.001). An acceptable agreement was found between the AIs in hopping and running, with a bias of 0.04 (−0.15–0.06) at imposed speed and 0.03 (−0.13–0.07) at preferred speed.

Conclusion
Our results suggest that testing an athlete for asymmetry in hopping might help to understand what happens in running. For this purpose, further research is needed, especially in an injured population, to better understand the association between biomechanical asymmetry in hopping and running.
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NewsBot · May 10, 2023

Return to sports following lower limb musculoskeletal tumor surgery—A systematic review
Metin Tolga Buldu, Federico Sacchetti, Adam T. Yasen, Sherron Furtado, Veronica Parisi, Craig Gerrand
08 May 2023

Background
Survivors of primary malignant musculoskeletal tumors often face long-term disability. Clinicians at present are unable to provide evidence-based advice about returning to sports, which is important for active patients.

Purposes
Identify patients returning to sports.
Describe the sporting activities in which patients participate.
Identify the outcome measures used to assess return to sport.
Identify barriers preventing return to sports.
Study design
Systematic review.

Methods
A comprehensive search strategy was used to identify relevant studies combining the following concepts: (1) Bone/Soft tissue tumor, (2) Lower limb, (3) Surgical interventions, and (4) Sports. Studies were selected according to eligibility criteria with the consensus of three authors (MTB, FS, and CG).

Results
Twenty-two studies were selected, published between 1985 and 2020, including 1005 patients. Fifteen of the 22 studies had valid data on return to sports, with 705 participants, of which 412 (58.4%) returned to some form of sport such as swimming and cycling, at a mean follow-up period of 7.6 years. Four studies directly compared limb sparing surgery and amputation; none of these were able to identify a difference in sports participation or ability.

Conclusion
There is insufficient published research to provide guidance for patients with respect to return to sports following musculoskeletal tumors. Future prospective studies are needed to collect better pre- and post-treatment data at multiple time intervals. Validated clinical and patient sports participation outcomes such as type of sports, level, frequency, and validated sports-specific outcome scores should be recorded. In particular, more comparison between limb sparing surgery and amputation would be welcome.
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NewsBot · Feb 26, 2024

Examination of the validity of the Injury-Psychological Readiness to Return to Sport (I-PRRS) scale in male professional football players: A worldwide study of 29 professional teams
Gordon Dunlop et al
25 Jan 2024

Perceived confidence is an important dimension of an athlete’s psychological readiness to return-to-play. However, there is no established and validated tool to evaluate confidence in professional football. This study aimed to provide preliminary evaluation of the internal structure of the Injury-Psychological Readiness to Return-to-Sport scale (I-PRRS) in a cohort of injured male professional footballers. Over an 18-month period, 29 teams from 17 leagues participated. Players sustaining injuries eliciting ≥
3 weeks’ time-loss were recruited. Cross culturally adapted to 4 further languages, the I-PRRS was administered on two occasions: 1) day before returning-to-training and 2) day before returning-to-match-play. In total, 113 injuries were recorded with 96 completed I-PRRS data sets collected. Confirmatory factor analysis indicated the I-PRRS was a unidimensional scale, with all items measuring the same construct. The scale demonstrated good internal consistency (ω = .88). When examining longitudinal invariance of the I-PRRS across administration time-points, indices of model fit supported scalar invariance. There was preliminary evidence of good internal structure for the I-PRRS in professional male footballers. However, before further research involving the I-PRRS can be endorsed, efforts to confirm or refute empirical developments pertaining to psychological readiness are necessary.
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Return to Sport After Injury

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Return to sport after calcaneal apophysitis (Sever’s disease)

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Hello from a returning podiatrist

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Return to Sport After Injury

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Return to sport after calcaneal apophysitis (Sever’s disease)

Return to sport after ankle sprain

Return to Sports and Physical Activities After First Metatarsophalangeal Joint Arthrodesis

Return to Sport in Athletes with Achilles Tendinopathy

Return to play after a foot fracture

Returning To Practice After a few years of Not being in Practice

Hello from a returning podiatrist

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