The Body May Be Ready, But is the Mind Ready to Return to the Sports Field?

Zachary Walston

One of the primary measures of success of an anterior cruciate ligament (ACL) rehabilitation program is the prevention of future ACL tears.

Yes is prevention so important?

First, let's consider the cost. ACL tears cost the US health system nearly $18 billion annually when you factor in surgery and rehabilitation. Second, reinjury rates are as high as 31% after 15 years and 17% after only 5 years.

To minimize retear rates, athletes and the rehabilitation team - physical therapists, athletic trainers, coaches, and parents - need to ensure the rehab process is completed. Unfortunately, many athletes return to sport (RTS) sooner than they should.

Adrian Peterson is not the standard.

How is Return to Sport Determined

Testing clusters - such as triple hop test, broad jump, and single-leg hop - are commonly used to determine whether an athlete is ready to return to sport. These clusters assess a patient's strength, power, and balance.

Testing clusters can be used to assess kinesiophobia - fear of movement - but only for a select few movements. These movements are conducted in a controlled environment - the clinic not a sports field during a competition - limiting their translation to the field.

In general, physical readiness only captures a piece of the return to sport puzzle.

Return to sport assessment, like injury prevention assessments, needs to be multifactorial. A strictly biomechanical focus - only looking at range of motion, strength, and power - is subpar. Psychosocial factors must be assessed.

Psychological readiness to return to sport is one of these factors.

In a recent study in the Journal of Atheltic Training, the Anterior Cruciate Ligament–Return to Sport after Injury scale (ACL-RSI) was used to measure psychological readiness for RTS. The questionnaire comprises 12 questions covering key aspects of RTS: emotions related to returning (eg, fear and frustration), confidence in sports performance, and appraisal of reinjury risk.

The study found age and psychological readiness displayed a predictive ability for return to preinjury level of sports, while conventional RTS tests did not. Of the 129 patients included in the study, 42% returned to their preinjury level within 2 years after surgery. Those who returned were older and had a better self-reported function and higher psychological readiness 9 months after surgery.

If someone is not psychologically ready to return to the high demands and unpredictability of sports competition, no amount of physical readiness will be enough. Both body and mind need to be honed and ready.

This research provides valuable information for all members of the rehabilitation team and can likely apply to injuries outside ACL tears.

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I am a physical therapist, researcher, and educator whose mission is to challenge health misinformation. You will find articles about health, fitness, medical care, psychology, and professional development on my site. As the husband of a real estate agent, you will also find real estate and housing tips.

Atlanta, GA

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