Robert A. Panariello MS, PT, ATC, CSCS
Professional Physical Therapy
Professional Athletic Performance Center
New York, New York
At the time the injured and/or post-operative athlete reaches the period in their rehabilitation for clearance to “return to play” to their sport of participation, many considerations will determine this medical approval. The athlete’s return to play endorsement will be determined by the team/ treating physician in conjunction with the information provided by the rehabilitation professional participating in the athlete’s care. As all medical conditions should be evaluated on an individual basis, “traditional” orthopedic condition considerations for medical clearance may include but is not limited to the following:
• Elimination of all pain and edema
• Restoration of joint integrity
• Restoration of all “normal” joint range of motion (ROM) of the affected extremity, neuromuscular and proprioception abilities, as well as the movement patterns necessary for the sport of participation
• Restoration of physical qualities of strength, power, and elastic abilities of the affected extremity
• The athlete’s demonstrated abilities to perform the skills of the sport of participation (i.e. sprint, jump, change direction, throw, catch, hit, etc.)
There certainly are additional considerations and factors dependent upon the specific athlete, their medical history, physical condition, and sport and team position of participation.
The return to play assessment is initiated with an examination of the athlete by their (team) physician. Much of the examination performed by the rehabilitation professional includes a “percentage” comparison of proficiency (i.e. 85%, 90%, etc.) when comparing to the involved extremity to the non-involved extremity in a variety of testing procedures such as ROM, strength and power levels, jump tests, hop tests, change of direction, and linear speed to name a few. There are documented and valid tests for all of the return to play testing criteria. However, when comparing the extremities, the rehabilitation professional should also acknowledge the period of deconditioning to the non-involved extremity during the initial rehabilitation period (especially after the post-operative limitations of an involved extremity surgery). An additional recommended return to play criterion should include the physical quality (strength, explosive strength, elastic reactive strength, and speed) requirements of the sport(s) of participation.
Fry and Kraemer published a study reviewing the physical qualities of nineteen NCAA Division I, II, and III collegiate football programs (981 starters and non-starter players at all positions) for the following physical test performances:
• 1 RM Bench Press
• 1 RM Back Squat
• 1 RM Power Clean
• Vertical jump
• 40 Yard sprint
The average physical quality recordings for all 981 participating football players of every position were recognized as follows:
• 1 RM Bench press 301 +/- 57 pounds
• 1 RM Back squat 407 +/- 78.5 pounds
• 1 RM Power clean 260 +/- 39 pounds
• Vertical jump 27.6” +/- 3.6 inches
• 40 Yard sprint 4.92 +/- 0.27 seconds
At the conclusion of a college football player’s rehabilitation, one may inquire if the athlete has the ability to demonstrate the physical quality scores documented in this study? If they are unable to do so should “return to play” be permitted as wouldn’t the opponents who have met these physical quality standards have a physical advantage placing the returning athlete at possible risk of injury? If the returning athlete does meet these test scores they may still be placed at a physical disadvantage as this study was published 25 years ago in 1991. How much bigger, stronger, more powerful, and faster are the present day college football athletes compared to those of 1991?
Another consideration would be a major league baseball pitcher rehabilitating from a shoulder surgery that is cleared to return to play. At this time of this clearance let’s assume the athlete demonstrates a maximum velocity 80 MPH fastball. With such velocity limitations the pitcher would likely continue to work to achieve their pre-injury fastball pitching velocities (i.e. 90+ MPH) prior to resuming actual game day competition. To return to game day competition with an 80 MPH fastball would likely result in very little success due to the inability to achieve the fastball pitch velocity standards of major league baseball. Why should this return to play “concept” be any different with athletes returning to other various athletic endeavours?
The required physical qualities of each male and/or female sport of participation are easily obtained with a little effort. Perhaps the athlete should be cleared to “return to practice” vs. “return to play” until the time the post-rehabilitated athlete has the competence to demonstrate the physical qualities required by their particular sport of participation. By demonstrating the physical qualities required by the sport of participation, the same qualities that are also demonstrated by their opponents, perhaps the returning athlete will be placed at less risk of re-injury.
Robert A. Panariello MS, PT, ATC, CSCS is a founding partner and Chief Clinical Officer at Professional Physical Therapy and the Professional Athletic Performance Center with 88 facilities in the NY, NJ, and CT tristate area. He has more than 35 years of experience in the related professional fields of sports physical therapy and the strength and conditioning of athletes, is well published in scientific and S&C journals, and lectures nationally on these related topics. He is a former Division I Collegiate and Professional Head Strength and Conditioning Coach and has studied the science of strength and conditioning and weightlifting in Bulgaria, the former Soviet Union and former East Germany. Rob was the recipient of the 2016 National Strength and Conditioning Association (NSCA) Sports Medicine/Rehabilitation Specialist of the Year Award, the 2015 American Physical Therapy Association (APTA) Sports Physical Therapy Section Lynn Wallace Clinical Educator Award, and was elected into the Collegiate Strength and Conditioning Association (CSCCa) Hall of Fame in 2003.