BRINGING SCIENCE TO TREATMENT
2017 England’s Ruben Loftus-Cheek holds his hip REUTERS/Dylan Martinez
“When can I return to sport (RTS)?” is the first question on any athlete’s mind after an injury. Those with femoral acetabular impingement (FAI) are no different. When the femoral head and neck misalign with the acetabulum, the resulting pressure impinges the labrum or rim around the acetabulum. Persistent impingement, usually classified as a CAM or Pincer impingement, leads to pain, labral tears, and degeneration of the joint. Physio Chris Mallac explained the mechanism of injury, diagnostic tests, and both open and arthroscopic surgical repair of FAI in a recent Masterclass article.
In part two of this Masterclass, Mallac extensively reviews the post-operative rehabilitation protocol and RTS criteria. The postoperative rehabilitation process takes anywhere from four to six months. While Mallac highlights several protocols and RTS tests, Swiss researchers recently investigated the RTS rates following arthroscopic repair of an FAI (1). They noted that most RTS studies reported RTS simply as a yes or no question; did the athlete return to playing a sport or not? The Swiss scientists, however, highlight that RTS is a qualitative entity, meaning athletes have a spectrum of sports participation to choose from. When studies site RTS rates, they neglect to specify if the athletes returned to their prior sport or level of performance after the intervention in question.
Rather than assume the RTS was to previous levels, the Swiss team surveyed 127 patients who received arthroscopic repair of an FAI. Of those, all returned to some level of sport or exercise participation. A mere 28% actually returned to their pre-injury sport and only 21% to their prior level of performance. The mean time to resuming previous sports participation after surgery was 8.1 months.
The participants in this study were athletes of varying levels of performance. Since all returned to participation, but roughly only one quarter to their prior sport, the authors suggest RTS reported along a continuum of activity may provide athletes with more realistic expectations of outcomes. They concluded that the 91% rate of RTS reported in the literature may mislead athletes into thinking nearly all who undergo arthroscopic repair for FAI return to prior levels of performance.
As physio Tracy Ward explains in her article on the psychology of RTS, managing expectations plays a role not only in RTS, but the incidence of re-injury as well. Defining exactly what RTS means to athletes helps to clarify their goals and set realistic expectations. No matter the type of injury, athletes benefit from explaining RTS as levels of participation and performance.
in Diagnose & Treat, Email Newsletters, Musculoskeletal injuries
Nearly 50% of sports injuries occur at the tendon(1). That tough yet semi-elastic piece of connective tissue that connects muscles to bones still seems to be the weak link in athletic movement. As Alicia Filley reviews, we’ve come a long way from thinking of it as a purely inflammatory problem. We now know that there... MORE
They defined RRIs to include, “any self-reported complaint involving muscles, joints, tendons, and/or bones deemed by the runner to be caused by running.” The RRI had to impact at least one running workout by requiring the runner to decrease their speed, distance, length of run, or the number of runs. In addition to RRIs,... MORE
in Ankle and foot injuries, Email Newsletters
Surveys report complaints of heel pain in 13.4% of respondents over 50-years-old(1). Amongst runners, the incidence of heel pain is even higher – over 20%(2). Although it often resolves on its own, posterior heel pain can be particularly stubborn. The plantar fascia can even rupture, as Chris Mallac explains in a recent article on... MORE
in Email Newsletters, Improve, Knee injuries
Runners suffer injuries at an alarming rate. Up to 80% of runners will report an injury each year! Most injuries are due to the inability of tissues to handle the loads applied to them. Often this is due to training error such as increasing distance or pace too quickly or taking on an aggressive... MORE
in Email Newsletters, Neck and back injuries
Sports professionals often equate dance with the arts rather than sport. However, dancers spend as much time, if not more, in training as other competitive sports (1). Dance encompasses the whole gamut of physical performance: power, strength, agility, speed, and flexibility. Therefore, it is no surprise that dancers suffer injuries too. In Australia, girls choose... MORE
in Diagnose & Treat, Email Newsletters, Improve
The days of lying in a dark room until concussion symptoms resolve are over. Research now shows that although exercise may make concussion symptoms worse, finding that sub-threshold level of activity –movement that doesn’t trigger symptoms – may help resolve the effects of a concussion(1). Concussive symptoms can be varied and, as Alicia Filley explains,... MORE
