return to play and re-injury risk

Footballers could reduce risk of re-injury with extra training before return to play

It doesn’t matter what sport you play, or at what level – the temptation to pull on the boots (or spikes, or cleats, or skis) after an injury is overwhelming. You’ve been put on a course of treatment, and you’ve been given a recovery schedule, but you feel that no-one knows your body better than you do. Big mistake, according to recent return to play research from the Football Research Group at Linkoping University in Sweden.

According to the study, injured footballers who skip a course of practice sessions before returning to full competition are more likely to aggravate their injuries – or even develop new ones – than those who are eased in gradually. And when it comes to the highest level of the game, professional matches have a seven-fold greater risk than practice ones for the returning player.

The research team went right to the top for their study: they examined data on 303,637 matches involving Champions League teams, and that data included 4,805 matches involving players returning to the field after moderate-to-severe injuries kept them in the treatment room at least eight days.

Their conclusions? Injury rates were 87% higher during players’ first match after an injury than they were for typical matches during the season. However, the study also discovered that with each practice session prior to the first match after an injury, players’ risk of another injury dropped by 7%.

So, what entails a proper practice session?

That’s not something the study was concerned with. “While we can’t say anything about the content of those training sessions, our data suggests that if they complete six training sessions after they have been cleared by the medical team to fully participate in all team activities but before they play a game, the risk of injury in that game is only marginally higher than the average risk in matches,” said Hakan Bengtsson, physiotherapist with the Football Research Group and lead author of the study.

[external link: https://bjsm.bmj.com/content/early/2019/08/28/bjsports-2019-100655.abstract]

According to Bengtsson, the biggest risk for repeat injury occurred with four practices prior to the first match, and made clear that he and the study team were aware that some players might not be able to wait for six training sessions due to various factors – but the results clearly demonstrate that rehabilitation alone may not be sufficient to prevent repeat injuries, due to the fact that most rehab procedures are conducted alone, away from the healthier members of the squad, and are no substitute for what they go through at the top of their game.

Let your team ease you back in

“When the player returns to full team training, it will be more similar to actual game play” he added. “And thus, full team training offers a better environment for the athlete to build tolerance to what he will be exposed to in matches.”

There’s a lot of truth in what the study team say, from my experience. All professional athletes who suffer an injury and go through rehab are champing at the bit to get back in the game as soon as any sign of progress happens. And even the most prudent coaches and managers don’t like to see their talent on the bench for too long. But in cases such as this, a gradual easing-in process is essential.

For more advice about returning to play after injury, contact sport injury specialist Mr Jonathan Webb. He offers clinics in Bristol (08450 60 44 99) and London (0203 195 2443).