return to play or performance Whos decision is it? Dr Andy Franklyn-Miller

WHAT IS return to play

place holder for video

Medical clearance for full participation in sports

without restriction

or PAIN Creighton 2010

No current lower extremity PPT has demonstrated reliability,

validity & responsiveness in RTP

Physical Performance Tests

British Journal of Sports Medicine. 2015: 49: 642-648

Clinician friendly lower extremity physical performance measures in athletes: A systematic review of measurement properties and correlation with injury, Part 1 & 2.

Hegedus EJ1, McDonough S2, Bleakly C3, Cook CE4, Baxter GD5

LACK OF standardisation leads

to MEDICOLEGAL OR FINANCIAL

IMPLICATION club vs country

But we know a lot about injury mechanism

and rehabilitation so why is it not easy?

Risk factors for injury (distant from outcome)

Mechanism of injury(proximal to outcome)

Intrinsic riskfactors

age

flexibility

previous injury

phenotype

predisposed athlete

susceptible athlete injury

inciting event

exposure to extrinsic risk

factors

Success

Injury

Reduce the Load Repair Joint / Tissue

Mechanotherapy “Increase tissue load tolerance”

Address Risk Factors (biomechanics, training load, environment)

Replicate sport-specific demands

Return to Play

Unstructured Excessive Loading

Well Structured Appropriate Loading

Traditional Periodization Model

Volumetechnique

General (GPP) Special (SPP) Competition Transition

intensity

STRENGTH IS NOT SIMPLE

EXPLOSIVE STRENGTH

ACCUMULATION I RESTITUTION 1 ACCUMULAITON II RESTITUTION II

DT

EXPLOSIVE STRENGTH

SPEED EMPHASIS

MAXIMAL POWER

SPEED EMPHASIS

DT

MAXIMAL POWER

SET EXPECTATIONS BASED ON SOLID EVIDENCE

manage pain

normal joint function and range for patient (surgery)

restore normal, then exceed absolute strength

Ability to generate that strength through

a range at rate appropriate to sport

Distribute load using segmental

coordination and control

Create fatigue resilience of multiple segments

Tolerate excess load and unpredictability

return to sport

SSC 6 Phases of rehabilitation

6 Reproducibility under fatigueBack to Performance

5Back to Sport Multi-directional Running

4Back to Running Linear Running

3Back to School & Work Power and Reactive Strength

2 Mobility, Control and Optimal Strength

1 Diagnosis and Assessment

Who is in Control of the RTP Decision?

the patient

via a system of objective

testing criteria with a return to

performance specificity

thank you