As athletes, nothing is worse than knowing your season is over due to injury. The endless sessions of rehab and physical therapy can be draining, both physically and mentally for an athlete. But learning to overcome injury and learning to rebuild your body in an efficient way is one of the most important times in any athlete’s career.
By the Numbers
In a recent study, 687 patients had a complete ACL reconstruction from 2009-2015. The patients ranged from ages 16-35. Of these 687 injuries, 169 of them came from contact, while 518 were non-contact injuries. 67% of ACL injuries occur on field turf.
What coaches must be aware of is how the body actually responds post-surgery. At 6 months, strength is about 97% pre-injury level. However, that should not be mistaken for being fully back. Rate of force production and rate of force development is actually only at about 63% pre-injury level. Even at 12 months post-op, the strength may be fully back to normal or even stronger, however, the rate of force production and rate of force development is still only at 90% pre-injury level. The risk of reinjury on the ACL is also increased by as much as 25%.
Just as important from a physical standpoint, we must understand that athletes need to be able to mentally prepare themselves to get back on the field after an injury of this magnitude. In a study done with 5770 participants, only 44 percent of these participants returned to competitive sport. That tells us that although they had been cleared to participate, they could not mentally get themselves to a more positive mindset.
The Art of Coaching
As coaches we will always rely on numbers and data as a way to be the best we can. However, there is certainly an art to coaching and we must be able to get our athletes to buy into our concepts – we have to get creative, especially when getting our athletes to return to play.
It all starts with collaboration. We need to get the athletes to trust us, we need to get the parents to trust and we need to even get the doctors trust in order for everyone to be successful. Communication is key during this process. Having lines of communication open, such as email or phone numbers, is important. We must then be able to show a commitment to the athlete. Commit to getting the athlete back from injury. This ties into being goal driven as well. Make sure we set goals and commit to achieving them as a team.
There are three A’s associated with returning to play – awareness, assessment, and attitude. We must be aware of not only what the athlete is dealing with physically, but also mentally. They may be thinking about a possible scholarship that is on the line, or other factors. The important thing is to be aware. As coaches, our job is to assess. We have to assess what works well, what works one day but maybe not the other. We have to constantly assess what is going on. Finally, we need to stay positive. We have to have a positive attitude with what we are doing because that will certainly reflect on the athlete. Three areas to monitor every day are: motivation level, concentration level, and level of confidence.
Programming + Progression
There is a hierarchy of athletic development, especially when returning from injury. It is important to notice what is at the bottom and what is at the top. Too often, steps are skipped or not paid enough attention, and unfortunately this is where injuries occur.
Programming + Progression is the best way to ensure that an athlete’s return to play will go as smoothly and as safely as possible. The model below gives an example of how to properly progress through an injury in a timely manner. It is based on testing and then programming only once it has been proven that the athlete is performing at a sufficient level.
Another important aspect of Programming + Progression is learning to also rebuild odd position strength. Many of the sports we play require us to “own a position” that may not be a normal position to be in. Reteaching the body and the brain to be in these positions is another important factor to getting back onto the field. Compound movements should be staple exercises for most programs to develop strength in key movement patterns that will translate to success on the field.
Building Mental Strength
As mentioned before, even after going through an entire recovery and progression program an athlete may be ready physically but mentally, we need to get them back to where they were before. This is called kinesiophobia – the fear of movement or motion. It is the most common reason cited for post-op reduction in or cessation of sports participation.
This is why consistency is so important. Keep the athlete focused on the goals set out early in rehabilitation. Remind them daily of these goals and teach them to celebrate the small victories. It’s very important to stay in touch with them even after they return to play. The job is not done once they get back, that is just one of the goals that was achieved. Don’t ever let them or yourself become complacent either. Motivation will be key throughout this entire journey.
There are many factors that an athlete will face during their career but recovering from injury may be one of the hardest. As coaches we must be able to help them take the appropriate steps to recovery in order to get them to return in a timely manner. Every player is different, so we must be able to adapt and understand each individual’s situation. Patience and consistency will be the best way to get them back to pre-injury level or even better.
About the Author
Sully Parker has been a Parisi Performance Coach since 2008 at the flagship location in Fair Lawn, NJ. In 2018, he was named Associate Master Coach by the Corporate Team. A lifelong athlete, Sully was awarded Bergen County All-Decade for the 55m for 2000-2010. A graduate of The College of New Jersey, Sully studied Exercises & Sports Science and competed in Track & Field and Football.