Returning Young Athletes to Sport Too Early Following Injury

Children, young adults, high school athletes, college athletes are more than often returned to sports much, much too early following injury. At times, it is gut wrenching how early some are returning or more so, the lack of testing, discussion, education and preparation for return to playing a sport.

More often that I’d like to admit, I see a kid following a second, or third injury - sometimes the injury is to the same body part, other times to a different one (which for some reason we think is independent of the first one - wrong). I’ll give an example from years ago, although I see this almost every month.

A 14 year old breaks his tibia (lower leg). He is in a cast for 6 weeks, non-weight bearing to allow the fracture to heal. Appropriate, needed. Upon return to get the cast off, he is x-rayed and told the bone has healed beautifully. What happens next baffles me. A provider says - yep he is healed and can return to playing soccer.

Wait a minute, the bone is healed. But what about the last 6 weeks of not using that leg? That just doesn’t come back. It needs to be strengthened, taught how to work again through movement and progressed back to the level he was at before. But, when returning to sport without any conditioning, the kid takes a “bad step” and now tears the ACL on that same leg. Devastating, now surgery and out for a year or more. Often “we can’t believe this happened”, when in actuality the ability to reduce the risk of this happening couldn’t be more clear.

When we are injured, in a cast, not putting weight through the leg - muscles lose strength, they atrophy. This kid could not do one single leg heel raise (up on the toes) - not one. When returning to jogging following ACL reconstruction it is expected the individual can do at least 15 repetitions of a single leg heel raise- to return to JOG, not to play.

Kids are resilient (as are adults) so for some reason, we think they should just “bounce back” and the pressure of returning to sport is high these days - and quite frankly - they feel good but when assessed there are so many key components of movement and strength that need to improve to allow full return to sport, as well as significantly reduce the risk of another injury. When we return anyone too fast to sport - the chances of them becoming a “chronic rehabber” are quite high. They are in and out of the doctor or physical therapy or chiropractic care for injury, after injury, after injury - maybe different injuries and we wonder “what is going on , what is wrong with them”. When in actuality it is just poor decision making about returning someone to sport.

Now, do we need to motivate and encourage kids to return to sports after injury - yes, but maybe they consciously or subconsciously do not have the confidence because their movement or strength is not there - if this is their first time injured and doctors, PTs, parents are saying - you’re fine - just get out there - then how do they know to speak up?

Trying to return kids to sport too quick after injury has a high cost — literally and figuratively. Imagine if the first injury was managed well and took 4 months to return vs 6 weeks. Short term, it sucks, really it does —> but long term the time out of sport is significantly reduced and many injuries are prevented.

Please, I implore you, take a step back when a kid has an injury, question quick returns to sport, be sure they are tested with movement, think about the ramifications and let’s take care of our young athletes so they can keep their social identify, stay healthy, and want to be active for the rest of their lives.