When developing a working model for a rehabilitation program, the medical staff—comprising the team physician, physical therapist, and athletic trainer—begins by presenting a clear and concise diagnosis that incorporates the initial injury assessment and any imaging results. Once the diagnosis is confirmed, the medical and performance team convenes for an in-depth review of various factors, including injury severity, pain levels, physical assessment findings, baseline testing scores (if applicable), therapeutic modality schedules, exercise programming, physical performance design, and the projected timeline.
This meeting is repeated multiple times throughout the Return to Play (RTP) process to ensure the athlete’s progress is closely monitored and aligned with a successful recovery. Regular staff meetings are essential for maintaining alignment among all team members regarding the diagnosis and recovery plan. These discussions ensure that each specific area and phase of the RTP program is thoroughly addressed, enabling the development of a comprehensive return-to-play strategy.
One of the key pieces of information in any injury case—and a foundational component of the model—is the orthopedic timeline of injury healing. These timelines serve as the starting point for your program and help guide exercise progression and selection. A wealth of research provides information and guidelines on the expected healing durations for specific injuries and their severities. Further reading can be found in the works of the following authors: Wohlfahrt M., Haensel L., Pollock N., McGonigle T., and Wallace H.
Timelines can be a slippery slope and even dangerous territory when discussing an injured player’s return with management and coaching staff. Depending on how strict and organized your process is, you can either look like a genius—or a fool. More importantly, the performance and medical staff may appear disorganized if the plan is rushed or forced, or if targets within the plan are missed or unrealistic due to committing to an arbitrary timeline.
A principle I’ve come to live by in the return-to-play (RTP) process is this: once the athlete is performing at a high level, workloads are being met, performance measures have returned to baseline (or exceeded them), and they feel confident in their return… I add another week. This ensures the player is fully prepared, giving them time to acclimate to another week of game-like loads, volumes, and intensities. Additionally, this extra time provides the athlete an opportunity to build even more confidence in themselves.
Sometimes, as coaches, we forget that a return-to-play (RTP) program is an excellent opportunity to build strength in the uninjured areas of the body, focus on energy system development, and address any existing weaknesses or imbalances. When properly programmed, the athlete can develop a higher level of strength and fitness, making the healthy areas of the body more robust while rehabilitating the specific injury site.
To make a lasting impact on the uninjured areas during either a short-term or long-term RTP program, it is critical that the exercise prescription includes appropriate dosing, progression, and intensity. Additionally, a coach can implement a testing battery for the uninjured areas to track progress and assess the effectiveness of the program.
One of the most important final aspects of the return-to-play (RTP) plan is preparing the athlete to be truly game-ready. Organized and controlled simulations of the sport are critical for helping the athlete adapt to the tactical, technical, physical, and mental demands of competition.
As the athlete enters this phase of rehab, the performance coach and sport coaching staff can apply various constraints to guide progression—such as small-sided games, timed play intervals (short or long), and situational starts to each play sequence. The possibilities are vast and allow for exposure to the specific demands the athlete will encounter upon reentering the lineup.
Each sport presents its own challenges when designing realistic gameplay scenarios. Factors such as having enough rostered players to form teams, surface availability, and travel schedules must be managed by the performance team when creating these game simulations.
BONUS…. WHO MAKES THE CALL?
A major milestone in the return-to-play (RTP) process is the athlete’s return to full participation in practice. For the athlete, this represents a significant step toward rejoining the lineup, as they reenter the team environment where camaraderie and enjoyment provide valuable motivation and support.
The decision for an athlete to return to practice involves collaboration among several key stakeholders: the physician, physical therapist (PT), athletic trainer (ATC), performance coaches, head coach, and the athlete. The next stage—clearance for full participation in competition—rests heavily on ongoing discussions between the performance coach, head coach, and the athlete.
Only after the athlete has participated in multiple practices, followed a progressive loading plan, engaged in game-like drills and scrimmages, and regained confidence in their performance can a final RTP date be determined. This is a critical juncture when all departments must collaborate to ensure the timing and context of the athlete’s return are optimal.
Return-to-competition decisions should never be rushed. The final decision must prioritize the athlete’s readiness and set the stage for the most successful and sustainable return possible.
Mike Potenza M.Ed., C.S.C.S, TSAC-F
Co-Founder, Metabolic Elite
Director of High Performance, San Jose Sharks
