Return to play
2nd International Sports Conference, Rio de Janeiro
From Bauerfeind Life Magazin
Injury patterns in sports are as international as sports themselves. Not only soccer player Marco Reus has had to deal with a recurring ankle injury. Did he start playing again too early? Dr. med. Kai Fehske from the University of Würzburg is working on an “early warning system.”
“When can I play again?” This question drives everyone: athletes, their doctors, and their families. When is the right time to train and compete again after an ankle injury? Standing before the conference participants, Dr. Fehske also posed this question of all questions. And even he himself was unable to answer it; not because the trauma surgeon and orthopedic specialist lacks expertise – quite the opposite – but because there is no answer to this question that is so frequently debated in athletic circles. At least there is no definitive recommendation. There are just too many variables in this game.
The number-one cause of twisted ankles: basketball
One third of all sports injuries involve the ankle. The most risky sport is basketball , followed by volleyball and football. The rate of recurrence is astounding. As a well-known example, Dr. Fehske named the German pro football player Marco Reus, who experienced a sprain that led to years of recurring injuries. In general , Dr. Fehske has identified two types of risk factors: intrinsic ones, such as muscle imbalances or limited neuromuscular control (see ref.), and extrinsic ones. The orthopedic specialist , who is also a sports scientist , also includes the characteristics of the ground, the type of shoe, and possibly even missing external stabilizers such as ankle supports. However, Dr. Fehske feels that what is decisive for a recurrence, and not just in the case of the football player Marco Reus, is something else entirely: a premature “return to play!”
Avoid the “return to doctor”
When returning to the playing field after ankle injuries, timing is crucial , the speaker emphasized. But Dr. Fehske also knows this is easier said than done. When has post-traumatic stress abated to the point when “return to play” doesn’t also mean “return to doctor”? In the part of his lecture entitled “tailoring therapy to specific stages,” his first recommendation was to look for associated injuries that might warrant a longer break. The most important factor, however, was rehabilitation which should be adapted to the individual situation of the athlete in question. This also included multidisciplinary approaches, such as proprioceptive training and diet. Dr. Fehske reported about a function test he is currently developing with his team at the University of Würzburg’s sports center. The goal is to identify any chronic instability of the ankle as early as possible. His lecture’s conclusion? Any premature return of the athlete that would increase the risk of re-injury or prolonged recovery must be avoided at all costs. And when in doubt , the decision should be made in favor of the athlete’s long-term health.
Ref.: Kobayashi T , Tanaka M, Shida M. Intrinsic Risk Factors of Lateral Ankle Sprain: A Systematic Review and Meta-analysis. Sports Health. 2016 Mar-Apr; 8(2):190-3.