Michael W. Goforth MS, ATC
Kevin Domboski, MS, ATC
Virginia Tech Center for Performance and Sports Medicine

Each year there are over 1 million high school athletes that participate in scholastic football. When you add Pop Warner, middle school, college/university and professional leagues for both men and women it is easy to estimate participation in organized contact football at over 2.5 million. With increased participation comes increased potential for injury. Now, I know what you are thinking. Football + Injuries = a bad thing. Let's face it, the potential for injury exists in all sports, not just football. Injuries occur in all sports and even occur during your common activities of daily living, so let's not point fingers at the great sport of football.

Tough Decisions
As a Division I Certified Athletic Trainer a lot of times my job depends on being able to get our athletes back out onto the field in a safe and effective manner as quickly as possible. As a parent of two boys that love football and a supporter of football on all levels in our community, I am often asked "how long will my son be out if he has ...?

This is a hard enough question to answer when we have all of the latest sophisticated diagnostic equipment as well as multiple physicians available for a good diagnosis. There is no easy way to answer these questions and it is in no way a black and white answer. The answer lies somewhere in that fuzzy gray area! The purpose of this article is to give you the athlete, parent or coach a common sense approach to making an educated guess on when is it safe to return to competition.

Baseline Data/Functional Testing
When an injury occurs, what objective information will we use to determine when that athlete is able to return back into competition? There will be plenty of subjective information such as feedback from the injured athlete. "It hurts bad", "I can play with this", "This is nothing" or "This is killing me". We have all heard these statements at one time or another and they do actually play a role in giving us some clues on whether or not it is safe to put an athlete back into competition or practice. What I want to focus in on is how much objective data that we have at our disposal that usually goes unused.

The majority of the quality football programs of all levels complete some sort of baseline testing. Vertical jump, 40 time, sit and reach, bench press, squat, 1.5 mile test and 16 x 110 test, etc... are all common, reliable test measures that are done as a preseason basis. These are great tests that can be repeated following an athlete recovering from an injury to let us know objectively how well they are prepared to return to their activity.

How do I use the data?
Look at the available data and see what measurements you have that can be done without causing the athlete any additional injury. Take into consideration whether or not the injury involves the upper extremity or the lower extremity. Which ever extremity is not affected by the injury can easily be trained and tested without fear of causing additional injury. You can also divide the body into hemispheres. If your right side is injured, why can't we continue to train and test the left side? Again, all common sense approaches to basic questions. Keep in mind that in the beginning, you won't be able to recreate each and every baseline test. You will have to progress the injured athlete through the tests to the point that they can safely execute all of the tests without an increased risk of re-injury. Common sense will guide you as well as the athlete's subjective feedback whether or not they are ready for the testing.

Quality vs. Quantity
What is the difference between an 8 and an 8.75 in gymnastics or competition diving? The difference is the quality of the execution of the movement. What is the difference between a 35" vertical jump and a 29" vertical jump? The difference is the quantity of the movement, simply put, one athlete jumped higher than the other. In looking at an injured athlete, we need to look at both the quantity and the quality of the injured athletes movements. If one or the other is lacking, you should never progress the athlete to the next level. Whether or not you are a medical professional or a laymen, if you can't analyze quality and quantity, then you better find someone that can (i.e. coach, certified athletic trainer, physical therapist, strength and conditioning specialist, etc...). In some cases, especially when dealing with objective items, it will be easy to measure and make an educated judgment. In other cases when you start to look at the subjective aspects, it can become more difficult. Trust your instincts and use common sense and you should be fine. For example if you have an athlete injure their ankle, what are you going to look for?

Can they stand on the injured foot? Yes or No? Do they lean or fall off balance?

Can they do a heel raise on the injured foot? Yes or No? Do they wince in pain?

Can they jump up and down on the injured foot? Yes or No? As high as the un-injured side?

Hopefully by now the light bulb is going on in your head and you are able to recognize what is subjective vs what is objective and what is quality vs quantity. Being able to recognize the difference will start you on the way to assessing whether or not the athlete is ready to progress.

Sport Specific > Position Specific > Individually Specific
Now that we have established the baseline information for which we will judge the readiness of an injured athlete, we can now get more specific with the things that we will be evaluating. It is easy to see that a tennis player has different sport skills than a softball player just as a basketball player has different skills from a football player. In designing the sports specific component of your training or evaluation to return an athlete back into participation following injury all you need to do is break down the individual components or skills that the athlete has to complete (Football: run, block, catch, throw, kick, tackle).

It becomes a little tougher when you start designing the position specific component of the program. Let's look at the quarterback position. What are the skills that a quarterback has to be able to master to run the offense (i.e. Quarterback: take a snap, 3 step drop, 5 step drop, throw the ball 20 yards, etc...)? All of these are activities that you can create to mimic actual playing conditions within a safe environment that will reduce the risk of re-injury.

The next step of designing an individually specific program is the one that requires the most imagination and advanced planning. The best example that I can think of is to look at the position of quarterback here at Virginia Tech. In the mid 90's we had Jim Drunkenmiller who was big, strong, more of a pocket passer. He threw for a bunch of yards and led us to a lot of victories. In 2000 we had a quarterback that some of you might have heard of, Mike Vick. Fast, quick, great arm and loved to work outside of the pocket. Here is a classic example of two people playing the same position for the same school, but playing it in a totally different manner. If these two individuals play the game different and have different styles of play then why should they have the same type of rehab protocol or functional testing?

The Virginia Tech Model
Here at Virginia Tech we pride ourselves in working together with the coaches and strength and conditioning staff to develop the best possible programs for our athletes and programs to insure that our athletes are ready to return safely back into participation without any increased risk of injury. This has to be a team approach and everyone must be committed to serving the best interests of the player and team.

We start out with the following baseline information and we can track it during their entire 4 or 5 years of eligibility:

I can use the data generated from these items to both develop and test and athlete's ability to participate. Again, this may seem simple but it in fact provides us with a very objective tool to make a subjective decision on whether or not an athlete is ready to return.

Another great tool that we utilize is the Metabolic Speed Pac that was developed by our strength coach (Mike Gentry). This is a series of ten plays/movements that are done at the same speed and intensity that would occur during a game and all of the movements are based on actual skills and movements performed in the course of a play. These movements can be randomly selected to change up the routine and one set of ten plays constitutes a quarter (10 plays equals 1 quarter, 20 plays equals 2 quarters, etc...) We use the speed pac as a way of ensuring that our returning athletes have the appropriate cardiovascular endurance levels to return to activity. In addition to the speed pac we have also developed position specific speed pac cards for each offensive and defensive position on our team using actual movements from plays. Again, another common sense item that takes some planning and work that gives you an excellent tool to predict the players status.

Example of the Metabolic Speed Pac