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Go or No-Go? How to Know When an Athlete’s Ready to Return

By Dev Mishra, M.D., 04/22/19, 8:30PM CDT

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Learn some tips to help sports parents and coaches with the difficult "go" or "no-go" decision when an injury occurs.

One of the toughest decisions for parents and coaches is deciding when an injured player is ready to return to action. The passion and energy of the game make it easy to get caught up in the moment and, possibly, allow an injured player to return to action before he or she is really ready. And that’s when a minor injury can turn into something more serious.

It comes down to this: It’s better to err on the side of caution. If you think a player’s not really ready, it’s better to sit them and maybe lose them for a few days, rather than to let them get back in before they’re ready and lose them for weeks. Or worse.

Whose Call Is It?

Ideally, the decision to return to play is not in the hands of the coach or parent. It’s in the hands of a medical professional, an athletic trainer or physician, someone who’s properly trained and qualified to make that decision. That’s even more important when returning from a serious injury such as a fracture, concussion, or surgery.

But there are many settings where a medical professional isn’t there to make a remove-from-play or return-to-play decision. This is especially common when an injury occurs on the field of play. In that case, it really comes down to the coach or parent to make a reasonable decision. 

When Players Insist They Are Ready To Play

Players love the thrill of competition, and, as such, want to back in the action as soon as possible.  This means they’ll often insist they’re ready to play when perhaps they are not. This is where the decision becomes really tough. You need to be their advocate but also look out for their best long-term interests. 

As the players get older, they’re going to have better reasoning and communications skills. They’re also going to have other motivations to stay in the game—and perhaps not tell you everything. 

With kids, you’ll often have to make the tough decision for their own good. What if you’re at an away tournament? What if it’s your star player? What if you have to play a player down? You still want to err on the side of safety. Always. Never sacrifice short term gains at the chance of long term problems.

Here are two simple observation tactics you can use to make a safe return-to-play call. 

Watch Closely When They Don’t Think You’re Watching

You might have a situation where a player was injured during practice midweek and you’ll have an opportunity to observe them in pregame warmup. If you see them noticeably limp, favor one side, or appear in pain during warmups, those are red flags indicating a more significant injury. Your best course of action would be to hold the player from play.

Do A Functional Test

If you can be reasonably confident the athlete really is pain-free and has no visible swelling then you’ll need to put them through a functional test. On the sideline ask the player to jog, cut, sprint and jump and observe closely. If the player can do that comfortably and with no visible problems that is a very good indicator of a return to play. For upper extremity injuries, you’ll want them to take practice throws, block, or whatever movement is necessary for the sport. These movements should be comfortable and with good accuracy, speed, and strength.

In a game situation, there are of course many grey areas. Following the advice above will help set you up for success. But if you have any doubts, don’t take a chance and risk turning the mild injury into something serious. Hold them out of action advise the athlete to consult a medical professional.


About Dev Mishra, M.D.

Dev Mishra, M.D., President, Sideline Sports Doc and Assistant Professor of Orthopedic Surgery, Stanford University, founded Sideline Sports Doc in 2010. He is double board certified in orthopedic surgery and orthopedic sports medicine.

 

ABOUT SIDELINE SPORTS DOC

Sideline Sports Doc develops health, wellness, and injury recognition solutions developed by national class team physicians, athletic trainers, and other healthcare professionals.

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