Bouncing Back

W hen an injury forces an athlete out of training and/or competition, the return-to-play (RTP) decision-making process may be simple or multidimensional. When analyzing these situations, an important factor to consider is why the injury occurred in the first place. Was the injury a result of an unavoidable trauma, such as a hit to the knee in a contact sport, or the result of fatigue or poor conditioning? Analyzing the causative factors, if they can be identified, may prevent a recurrence. When injuries require surgery, the preoperative preparation of the athlete may require days, weeks, or months. Sensing the athlete's physical and psychological preparedness is an important aspect of surgical care. Failure to detect those not prepared can complicate the recovery process from the start. During the rehabilitation phase, postsurgical testing often exposes significant deficiencies in the noninjured extremity that can improve the athlete's risk factors and performance. Examining both the injured and noninjured extremity may well be worth the time and effort. Spending time with the athlete and possibly the team athletic trainer, coach, or family members may identify obstacles to a successful return to sport. As this process evolves it may become obvious that the choice of sport was not ideal and that the athlete may need to switch to a more compatible endeavor. Making a long distance runner out of a flat-footed, valgus knee individual with a body mass index of 35 kg/m 2 may not be possible. Similarly, some undersized football players with repeated concussions or stingers may need to reconsider their athletic pursuits. As musculoskeletal specialists, it is easiest to focus on what we know best about the injured body part. However, missing psychological/emotional factors can pose problems for us and the athlete. Considering those factors before surgery and making sure that the athlete is ready for the increased rigors of postoperative rehabilitation is critical. Adjusting to the injured status may take time for the athlete even when it seems that everyone involved wants to move ahead with surgery and rehabilitation as soon as possible. For many athletes, their physical ability and wellness is central to their identity. When this persona is shattered, even the best athletes will struggle. This time sequence between injury and recovery can be highly emotional as the athlete struggles to conceal the fear and uncertainty hidden deep inside. Anger may surface even in the most well-rounded players. The musculoskeletal clinician …