Safe Return to Play After Injury

Playing sports provides a lot of advantages for children, from the benefits of exercise to improved self-esteem and cognitive abilities. But, as every parent knows, sports also come with the risk of injury.

While it’s tempting to allow children to return to play as soon as they seem able, it’s important to give the injury enough time to heal properly. That’s why the sports medicine team at Arkansas Children’s follows “safe return to play” protocols to ensure that children are ready physically and mentally to get back in the game after injury.

“The goal of treatment is for children to get back to their sport and stay there,” said Brant Sachleben, M.D., chief of pediatric orthopedics and co-director of sports medicine at Arkansas Children’s Hospital. “We want them to get back as fast as possible, but in a way that doesn’t create a secondary injury.”

Meeting the Criteria

When a child has gone through treatment for an injury, Dr. Sachleben and his team go through three questions before clearing that patient to return to playing the sport:

• Is it safe? This means determining whether the treatment was successful and the injury has had enough time to heal, ensuring there is not a high risk of reinjury.
• How bad is the pain? The answer to this question depends on the type of injury. “Some injuries might cause considerable pain but not damage,” Dr. Sachleben said. “Whereas others might not be that painful but are still not safe to play on. For example, after an ACL tear, the knee might feel better after about six weeks, but playing on it would risk long-term damage.” Answering the third question relies on proper healing and tolerable pain levels.
• Is the child able to function at the level they need to? In other words, the child must be able to return to playing near the level they were before the injury.

Safety First

To determine whether a child is ready to return to play safely, the sports medicine team often has the patient undergo a series of physical tests, depending on the type of injury. For example, after an ACL reconstruction, the child may undergo strength testing to ensure the injured knee has at least 85% of the strength of the non-injured knee. Other tests include movement and jump tests.

"We also look at mental readiness because being ready to return is not just physical," Dr. Sachleben said. "You also get mental scars after an injury, and those can heal at different rates for different people. We use survey questions to ensure the patient is ready mentally to return to the sport."

Safe Return After Concussion

After a child suffers a head injury that causes a concussion, it’s very important to monitor the child carefully and ensure they do not return to activity too soon.

“Symptoms should be completely resolved,” said Michael Israel, M.D., sports medicine director at Arkansas Children’s Hospital. “The child should be able to complete full days at school in addition to moderate physical exertion before returning to any contact activities.”

The sports medicine team uses an active rehabilitation method, which means the child gradually returns to normal routines.

"While we want to get young athletes back to activity quickly, safety and health are always our primary motivation," Dr. Israel said. "Active rehabilitation keeps patients engaged and concentrated on their recovery."

If any concussion symptoms worsen or come back during the recovery period, this is a sign that the child should slow down and see their healthcare provider.