Reconditioning - The Gray Area

Reconditioning is defined as the period of time that the athlete’s emphasis changes from a total focus on therapy to a return to play. Often this period is referred to by many therapists as the gray area; I personally think a better term might be the dark hole. This is the period of time when there seems to be much confusion about what the athlete should do, how much, how often and when. It seems that there are two approaches, one that says the athlete is never able to return to play, so they are stuck in a time warp or the other tough guy approach that dumps the athlete immediately back into competition, the sink or swim approach. Obviously there are huge flaws with both approaches.

Here is an approach that I propose that has worked well over the years. First the reconditioning phase is divided into two sub phases. The first sub phase is the return to training. The second sub phase is the return to game. The key to the success in all of this is that it is NOT protocol driven, it is criteria driven. By that I mean there are tasks or milestones that the athlete must achieve before moving on to the next segment of the program. A protocol is time based, in essence it is like social promotion in school, after one week the athlete is magically ready to move to the next step and the next step and so on. This is flawed because everyone progresses at different rates, some athletes are fast adapters and other slow adapters, some were at a higher fitness or skill level before they were hurt. All of this demands an individual plan for each athlete that has criteria defined for progress to the next level. A good starting point is the base level testing data that was taken before the athlete was hurt. Those scores on tests like the 30 second cones jump, agility, or a sprint all represent the 100% score that the athlete is capable of. It is unrealistic to expect the athlete to return to 100% on all tests, I think they should be at the 90% level before being returned to play. Over the years I have worked out criteria steps that the athlete must achieve in different sports that allow them to gradually return completely into practice. Once they are able to fully practice for an agreed upon time by all those involved then and only then are they returned to play. At that point if it is a team sport and they are a starter they must be available to return to playing the full time they were playing before injury. I have found gradually phasing them into games makes the psychological transition that much tougher. For this to work there must be flawless communication between all concerned, above all the athlete must be an active participant with good feedback. Be sure to video as much as possible to document the criteria skills as they are achieved. This may seem time consuming and to a certain extent it is, but this will assure that the athlete is 100% ready to go with the chance of reinjury minimized.