Back to sport after an injury

The pain has gone. You can walk, climb stairs and sit through a workday without thinking about your knee. So you go back to five-a-side, sprint for the first loose ball, and feel it go again.

It is a common story, and it often comes down to one mistake: treating "it doesn't hurt any more" as if it meant "it's ready".

Pain free is not the same as ready

In 2016 a group of 17 sports clinicians met in Bern, Switzerland, and wrote a consensus statement on returning to sport after injury. Their main point was that going back is a gradual process that runs alongside rehabilitation, and should not be treated as a single yes-or-no decision at the end of it¹.

They described three stages. First you return to participation: you are training again, but in a limited or adapted way. Then you return to sport: you are playing, but not yet at your old level. Last comes return to performance, when you are back to where you were before the injury, or better.

They also said the decision should be shared. The athlete, the clinicians and the coach each know something the others don't.

The final phase

South Africa's Health Professions Council describes Biokinetics as "final-phase" rehabilitation². This is the stretch between the end of early treatment and a full return to sport, and it is exactly where people tend to rush.

A Biokineticist starts by measuring. How strong is the injured leg compared with the other one? How is your balance on each side? Can you hop, land and change direction without favouring it? Those numbers decide where the programme begins.

From there the load goes up in steps: strength first, then speed and power, then the particular movements your sport demands. A runner's programme and a netball player's will look quite different by the end, even for the same injury. The tests are repeated along the way, so the decision to go back rests on measurements.

Preventing the next one

Exercise also lowers the chance of getting hurt in the first place.

A 2014 analysis in the British Journal of Sports Medicine pulled together 25 trials with 26,610 participants. Strength training cut sports injuries to less than a third. Overuse injuries, the kind that creep up on runners and swimmers, were almost halved. Stretching showed no protective effect³.

In football, a warm-up programme of running, strength and balance exercises called FIFA 11+ has been tested in several trials. A 2017 review found that it reduced injuries by 39%⁴.

Two cautions. These are averages across large groups, many of them young players in organised teams, so nobody can promise an individual the same result. And a programme only works if it gets done, week after week.

Stronger, even when nothing is wrong

Biokineticists also work on performance². You do not have to be injured to benefit from knowing which muscles are weak, where you are stiff and how your two sides compare. Finding that out in the off-season costs a lot less than finding it out halfway through a race.

Where a Biokineticist does not fit

A fresh injury that is swollen, unstable or very painful needs a doctor or a physiotherapist first. Biokinetics comes after the diagnosis and the early treatment. Many people arrive on referral from a doctor, physiotherapist or Chiropractor, and a Biokineticist will send you back to one of them if something does not look right.

This article is general information and not a diagnosis. If you are coming back from an injury, come in for an assessment.

References