RETURNING TO SPORTS POST-PANDEMIC
As we move into the summer and restrictions continue to be lifted, we all hope we’re closer to playing and watching sports again. Throughout this transition to higher activity levels, it’s important for therapists to understand the concept of load management and be able to educate parents and coaches on strategies to help decrease the risk of injuries.
Benefits of Sports Participation
Perhaps the thing we all miss the most about sports right now is a reason to get out of the house and socialize with others. As physical therapists, we know how important sports participation is to a child’s development. Sports bring with them a platform for developing friendships and teamwork skills, as well as physical literacy with the fostering of movement competency and confidence. Being active with greater than 60 minutes of activity each day is now widely accepted for children to optimize health outcomes. However, with exercise and sports participation comes the risk of injury. To reduce the risk of injury it is important to make sure our patients, families, and coaches don’t jump in too quickly.
Understanding Load Management
The biggest concern with the return of sports is athletes being expected to be in mid-season form when they return. Without the appropriate physical preparation, the likelihood of sustaining an injury will increase. The general process of guiding activity increases to reduce the risk of an injury is known as Load Management.
Generally speaking, Load Management is intuitive to a physical therapist. We would never recommend someone to run a full 26.2-mile marathon next week if they’re starting training tomorrow – it doesn’t make sense. This would be a massive spike in running activity. Inevitably, something on their body would break down due to a lack of adaptation to the load requirements of a marathon. Instead, we would recommend beginning with shorter
distance runs and gradually increasing their running volume over time. The more challenging problem is how to progress their volume (“Load”) while reducing the chance of sustaining an injury.
In higher-level sports, limitations on activity levels are often based on activity data. This can range from GPS tracked running mileage or sprint speed, to the number of balls tossed in baseball or pitch velocity. Using this data, we can carefully allow an athlete to return to an activity while trying to reduce their risk of injury by avoiding spikes and integrating rest periods.
Youth sports typically don’t have access to high-tech equipment. However,
that may not be necessary in order to monitor the loading of a youth athlete. The monitoring number of throws, distance run, or time of activity may be sufficient. Educating coaches and parents on the basics of Load Management and to avoid large spikes in activity could help prevent some injuries from occurring.
Getting Back to Sports
Just as we wouldn’t run a marathon without training, we shouldn’t let kids go back to high amounts of activity without an on-ramping period. When looking at the professional teams who are attempting to resume their seasons this summer, they have all built-in several weeks of on-ramping training prior to competitive play. These training weeks are designed to develop skills and build up load capacity.
A common perception is that kids are much more physically resilient than adults and can take on a lot more activity without negative consequences. Although there is some truth to this (the body doesn’t recover at 30 like it used to!), kids and adolescents are susceptible to various types of overuse injuries that adults are not. A youth athlete’s level of
physical development and the sport they play may set them up for various types of injuries. For example, youth baseball players with open growth plates in the upper extremities are at risk of developing Little Leaguer’s Elbow or Shoulder, while a youth soccer player or cross country runner may be at a higher risk of developing Sever’s Disease or Osgood Schlatter’s. Stress fractures and patellofemoral pain syndrome are common among youth athletes as well. By slowly increasing activity levels, the likelihood of these injuries may be decreased.
For parents or coaches who are less versed in injuries that a youth athlete is susceptible to, it may be very tempting to jump straight into mid-season volumes and make up for lost time. Instead, a general rule of thumb
is to start activity levels at between 25-50% of their typical “pre-isolation” volume of activity and increase activity levels by around 20% per week until they get back to their goal volume. This rule can be applied to things like throws in baseball and distance covered in swimming and running.
For example, if the goal for a junior high cross-country runner is to run 25 miles/week, a good starting distance may be 12 miles the first week and 15 miles the next. Within about 1 month they will be at their target volume. Another example is a dancer who, under normal circumstances, practices 20 hours per week over 5-6 practices. A good starting volume may be between 5 to 10 hours per week with a greater focus on technique and less on jumping volume, and progress both
intensity and total volume slowly from there. This may help decrease the risk of sustaining an injury and having to take time away from their sport again later.
ABOUT THE AUTHOR: GRANT POSTON, DPT
Grant Poston, DPT, is a physical therapist in the Division of Occupational Therapy and Physical Therapy at Cincinnati Children’s. He specializes in sports physical therapy with special interests in ACL and knee injuries, Blood Flow Restriction training, weightlifting, and load management.