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Chiropractic Treatment: Research Review: Return To Play Following Sports Injury

RTP Ardern (2016) – 2016 Consensus statement on return to sport from the First Word Congress in Sports Physical Therapy, Bern

- Defining Return to Sport

o The minimum information required to define RTS is: the sport and the level of participation the athletes aims to return to.

o RTS is a continuum comprising three elements

▪ Return to participation

▪ Return to sport

▪ Return to performance

o In certain situations, the RTS decision may be reversed to a removal from sport decision

o The RTS decision should be shared among all stakeholders (except in the case of health risk to the athlete)

- Models to help understand and guide the Return to Sport Process

o The Strategic Assessment of Risk and Risk Tolerance (StARRT) framework – guiding the RTS decision

o Biopsychosocial model – addressing the best interests of the athlete

o Optimal loading – the Goldilocks approach

▪ Using the acute:chronic workload ratio for rehabilitation

o Considering the biological, psychological and social factors influencing the RTS decision and transition can assist the clinician to optimally contribute to the shared RTS decision

o The composition of, and roles within the decision making team should be determined as early as possible

o Members of the RTS decision-making team should be prepared to regularly share information among all relevant stakeholders

o Regular assessments and review of goals should be scheduled - What evidence do we have to inform the clinician’s contribution to the shared Return to Sport decision?

o Closed skill testing and open skill testing

o Physical readiness

o Psychological readiness

- Groin

o Decreased adduction strength associated with injury

- Achilles tendon rupture

o 4-5 months recovery for return to sport

- Achilles tendinopathy

o Those who do a structured protocol are less likely to have a relapse

Buckthorpe (2019) – Update on functional recovery process for the injured athlete: return to sport continuum redefined

- 3 Elements of the return to Sport Continuum

o Return to participation

o Return to sport

o Return to performance

Dijkstra (2016) – Return to play in elite sport: a shared decision-making process - Shared-decision making

o Choice: making the athlete and coach aware that reasonable options exist

o Option: providing more detailed information about the different option

o Decision: guiding the athlete and coach to consider their preference and decide what is best

- Shared-decision making improves satisfaction and reduces decisional conflict in healthcare

- The healthcare professional’s role is objective – to accurately inform the athlete and coach about health status and risk. The athlete and coach ultimately evaluate the information and make a decision about RTP

Taberner (2019) – Progressing rehabilitation after injury: consider the ‘control-chaos continuum’

- High control

o Aims: Return to running with high control over running speeds/loads, low musculoskeletal impact forces, building player confidence

-Moderate control

o Aims: introduce change of direction with the ball, reduce control (somewhat controlled chaos) and high speed running progression

- Control to chaos

o Aims: introduce football specific weekly structure to overload game-specific demands reflecting a transition from control to chaos (inclusion of limited volume of movements with unanticipated actions)

- Moderate chaos

o Aims: increase high speed running under moderate chaos (unpredicted movements, minimal limitations), with the addition of pass and move and specific patterns of play drills

- High chaos o Aims: Return the player to relative weekly training demands and include drills designed to test worst-case scenarios (high speed, high chaos)


Dr. Mike Hadbavny

Chiropractor, Sports Sciences Resident RCCSS(C)

If you are interested in learning more about how chiropractic care can be effective for your particular condition or health goals, contact Dr. Mike Hadbavny at 250-881-7881 today to make an appointment and discover the many benefits of seeing a chiropractor in Victoria BC. Contact us today.

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