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Rehabilitation is the Critical Ingredient to Optimize Return to Sport in Athletes

      Abstract

      Medical providers, rehabilitation specialists, and researchers must incessantly refine and adjust specific protocols, understanding that rehabilitation is the critical ingredient for return to sport in athletes. This month introduces a Special Issue in Arthroscopy, Sports Medicine, and Rehabilitation entitled “Rehabilitation and Return to Sport in Athletes.” The articles have been authored by invited experts and rehabilitation specialists deemed thought leaders. The goal of the issue is to provide readers, researchers, and clinicians high-yield and high-impact articles that will optimize return to sport in athletes. For athletes, and non-athletes alike, there lies an essential quartet for recovery: 1) correct diagnosis, 2) restoration of anatomy, 3) biological healing, and 4) functional rehabilitation. Most importantly, a coordinated rehabilitation program must be chosen with appropriate specialization to synchronize the return to play. This Special Issue explores specific rehabilitation paradigms regarding return to sport using evidence-based medicine with support from literature to optimize the functional return of athletes.
      It almost goes without saying that rehabilitation is a critical ingredient for return to sport in athletes. We say almost because many of us, perhaps, fail to stress this paradigm enough to our patients recovering from injury and/or surgery before they return to play. Almost because we may all be guilty of forgetting to follow a coordinated, research-driven algorithm directed by a rehabilitation specialist. Once we have made our diagnosis and have verified that anatomy has been restored (with or without surgery), we send athletes on their not-so-nimble way to recover, almost forgetting the exact nuances of the protocols and modalities that will ensure their optimal return to their field, court, pool, course, track, or other venue of choice. As medical providers, rehabilitation specialists, and researchers, we must incessantly refine and adjust specific protocols, understanding that rehabilitation is the critical ingredient for return to sport in athletes.
      This month’s Special Issue in Arthroscopy’s companion, peer-reviewed, and open-access journal Arthroscopy, Sports Medicine, and Rehabilitation (ASMAR) is entitled “Rehabilitation and Return to Sport in Athletes.” Although ASMAR lists “rehabilitation” at the end of its title, here we are stressing it as the foremost ingredient. The 32 articles included have been authored by invited experts and rehabilitation specialists deemed to be thought leaders in their field. The goal of the issue is to provide readers, researchers, and clinicians with high-yield and high-impact articles that will optimize return to sport of athletes. This compendium comprises up-to-date techniques and modalities in therapy supported by the literature to optimize function and recovery.
      For athletes, and non-athletes alike, there lies an essential quartet for recovery: 1) correct diagnosis, 2) restoration of anatomy, 3) biological healing, and 4) functional rehabilitation. An accurate diagnosis is compulsory to make appropriate treatment plans, without which the patient is sent on a circuitous, potentially risky path. Precise restoration of anatomy may be required with or without surgery to restore proper biomechanics. An appropriate milieu must be provided for biologic healing. And most importantly, a coordinated rehabilitation program must be chosen with appropriate specialization. This quartet must be synchronized to yield optimal return to sport, work, or daily activities. Perhaps a preferred choice to “return to sport” is the term “return to function” whether it be sport or work, young or old, female or male, and novice or professional.
      This ASMAR Rehabilitation and Return to Sport Special Issue highlights a wide range of topics focusing on general rehabilitation principles, timing, coordination, and implementation while also delving into specific care modalities. In addition, there are age and gender considerations, sport-specific emphases, and level of participation, such as recreational versus professional. Specifically, the general topics include a holistic approach to an injured athlete,

      Paster E, Sayeg A, Armistead S, Feldman MD. Rehabilitation using a systematic and holistic approach for the injured athlete returning to sport. Arthrosc Sports Med Rehabil In press.

      a “continuum” approach of return to sport in professional athletes,

      Draovitch P, Patel S, Marrone W, Grundstein MJ, Grant R, Virgile A, Myslinski T, Bedi A, Bradley JP, Williams RJ III, Kelly B, Jones K. Return to sport clearance continuum is a novel approach towards return to sport and performance for the professional athlete. Arthrosc Sports Med Rehabil In press.

      defining “failed conservative management” for appropriateness to surgery,

      Rhon DI, Tucker CJ. Nonoperative care including rehabilitation should be considered and clearly defined prior to elective orthopaedic surgery to maximize optimal outcomes. Arthrosc Sports Med Rehabil In press.

      and a general overview of strength and power testing.

      Fares MY, Khachfe HH, Salhab HA, Bdeir A, Fares J, Baydoun H. Physical testing in sports rehabilitation: Implications on a potential return to sport. Arthrosc Sports Med Rehabil In press.

      Expert opinion delving into specific modalities include blood flow restriction

      Hedt C, McCulloch PC, Harris JD, Lambert BS. Blood flow restriction enhances rehabilitation and return to sport: The paradox of proximal performance. Arthrosc Sports Med Rehabil In press.

      ,

      Cognetti DJ, Sheean AJ, Owens JG. Blood flow restriction therapy and its use for rehabilitation and return to sport: Physiology, application and guidelines for implementation. Arthrosc Sports Med Rehabil In press.

      in the proximal and distal aspect of a limb, dry needling,

      Gregory TJ, Rauchwarter S, Feldman MD. Rehabilitation using acute dry needling for injured athletes returning to sport and improving performance: Clinical commentary on the theoretical use of acute dry needling to aid in the recovery and performance of athletes. Arthrosc Sports Med Rehabil In press.

      and antigravity training techniques in runners.

      Vincent HK, Madsen A, Vincent KR. Role of anti-gravity training in rehabilitation and return to sport after running injuries. Arthrosc Sports Med Rehabil In press.

      Rehabilitation and return to sport in women athletes are tackled generally

      Gianakos AL, Abdelmoneim A, Kerkhoffs GM, Mulcahey MK. Rehabilitation and return to sport of women athletes. Arthrosc Sports Med Rehabil In press.

      and female overhead athletes are addressed specifically,

      Boudreau SL, Mattes LL, Lowenstein NA, Matzkin E, Wilcox RB. Customizing functional rehabilitation and return to sport in the female overhead athlete. Arthrosc Sports Med Rehabil In press.

      highlighting the particular needs of their recovery. Sport- and work-specific functional recoveries are detailed among trail runners,

      Vincent HK, Brownstein M, Vincent KR. Injury prevention, safe training techniques, rehabilitation, and return to sport intrail runners. Arthrosc Sports Med Rehabil In press.

      soldiers,

      Rhon DI, Teyhen DS, Kiesel K, Shaffer SW, Goffar SL, Greenlee TA, Plisky PJ. Recovery, rehabilitation, and return to full duty in a military population after a recent injury: Differences between lower extremity and spine injuries. Arthrosc Sports Med Rehabil In press.

      pilots,

      Hohmann H, Pieterse R. Pilots following shoulder surgery and rehabilitation in a dedicated musculoskeletal rehabilitation unit of a major airline returned to work earlier when compared to standard rehabilitation by external providers. Arthrosc Sports Med Rehabil In press.

      and softball players.

      Colbert L, Harrison C, Nuelle C. Rehabilitation in overhead athletes with thoracic outlet syndrome. Arthrosc Sports Med Rehabil In press.

      Hip rehabilitation and return to sports address functional movement assessment and clinical decision making,

      Campbell AM, Voight ML. Beyond the basics of athletic hip evaluation. Arthrosc Sports Med Rehabil In press.

      rehabilitation after gluteus medius and minimus tears,

      Ilizaliturri VM Jr, Zepeda Mora R, Rodriguez Vega LP. Rehabilitation after gluteus medius and minimus treatment. Arthrosc Sports Med Rehabil In press.

      capsulolabral adhesions and reducing the revision rate for hip arthroscopy,

      Philippon MJ, Ryan M, Martin MB, Huard J. Capsulolabral adhesions after hip arthroscopy for the treatment of femoroacetabular impingement: Strategies during rehabilitation and return to sport to reduce the risk of revision. Arthrosc Sports Med Rehabil In press.

      and advanced rehabilitation after arthroscopy for femoral acetabular impingement.

      Geeslin AG, Holling MJ, Miller ST. Rehabilitation and return to sport after arthroscopic treatment of femoroacetabular impingement: A review of the recent literature and discussion of advanced rehabilitation techniques for athletes. Arthrosc Sports Med Rehabil In press.

      Specific anterior cruciate ligament (ACL) injury topics compose prehabilitation before surgery,

      Cunha J, Solomon DJ. ACL prehabilitation improves postoperative strength and motion and return to sport in athletes. Arthrosc Sports Med Rehabil In press.

      contemporary principles,

      Badawy CR, Jan K, Beck EC, Fleet N, Taylor J, Ford K, Waterman BR. Contemporary principles for postoperative rehabilitation and return to sport for athletes undergoing anterior cruciate ligament reconstruction. Arthrosc Sports Med Rehabil In press.

      ACL testing,

      Gokeler A, Dingenen B, Hewett TE. Rehabilitation and return to sport testing after anterior cruciate ligament reconstruction: Where are we in 2021? Arthrosc Sports Med Rehabil In press.

      how rapidly to return to sport after ACL reconstruction,

      Waldron K, Brown M, Calderon A, Feldman M. Anterior cruciate ligament rehabilitation and return to sport: How fast is too fast? Arthrosc Sports Med Rehabil In press.

      and the use of anterolateral ligament augmentation.

      Coquard M, Carrozzo A, Saithna A, Vigne G, Le Guen M, Fournier Y, Hager J-P, Vieira TD, Sonnery-Cottet B. Adding an anterolateral ligament reconstruction does not delay functional recovery after ACL reconstruction: A matched-paired analysis from the SANTI study group. Arthrosc Sports Med Rehabil In press.

      Two papers spotlight ACL reconstruction rehabilitation in the pediatric

      Matsuzaki Y, Chipman D, Hidalgo Perea S, Green DW. Unique considerations for the pediatric athlete during rehabilitation and return to sport following ACL reconstruction. Arthrosc Sports Med Rehabil In press.

      and adolescent

      Nyland J, Pyle B. Self-identity and adolescent return to sports post-acl injury and rehabilitation: Will anyone listen? Arthrosc Sports Med Rehabil In press.

      populations, with the latter focusing on self-identity. Several articles summarize additional knee pathology topics pertaining to return to sport after cartilage restoration procedures,

      Wagner KR, Kaiser JT, DeFroda SF, Meeker ZD, Cole BJ. Rehabilitation, restrictions, and return to sport after cartilage procedures. Arthrosc Sports Med Rehabil In press.

      anterior knee pain with a biomechanical perspective,

      Theisen BJ, Larson PD, Chambers CC. Optimizing rehabilitation and return to sport in athletes with anterior knee pain using a biomechanical perspective. Arthrosc Sports Med Rehabil In press.

      medial patellofemoral complex reconstruction,

      Lampros RE, Wiater AL, Tanaka MJ. Rehabilitation and return to sport after medial patellofemoral complex reconstruction. Arthrosc Sports Med Rehabil In press.

      and multi-ligament knee reconstruction.

      Monson J, Schoenecker J, Schwery N, Palmer J, Rodriguez AP, LaPrade RF. Postoperative rehabilitation and return to sport following multi-ligament knee reconstruction. Arthrosc Sports Med Rehabil In press.

      Finally, a foursome of papers delivers perspectives on shoulder pathology including return to sport after shoulder stabilization procedures,

      Otley T, Myers M, Lau BC, Taylor DC. Return to sport following shoulder stabilization procedures: A criteria-based testing continuum to guide rehabilitation and inform return to play decision-making. Arthrosc Sports Med Rehabil In press.

      upper extremity injury,

      Oak SR, Klein B, Verma NN, Kerzner B, Fortier LM, Chava NS, Reinold MM, Bedi A. Rehabilitation and return to play of the athlete after an upper extremity injury. Arthrosc Sports Med Rehabil In press.

      thoracic outlet syndrome,

      Colbert L, Harrison C, Nuelle C. Rehabilitation in overhead athletes with thoracic outlet syndrome. Arthrosc Sports Med Rehabil In press.

      and a biomechanical analysis of the throwing athlete.

      Trasolini NA, Nicholson KF, Mylott J, Bullock GS, Hulburt TC, Waterman BR. Biomechanical analysis of the throwing athlete and its impact on return to sport. Arthrosc Sports Med Rehabil In press.

      This Special Issue primer is a go-to resource to help clinicians implement insightful change now.
      Taken in sum, this Special Issue explores specific rehabilitation paradigms regarding return to sport using evidence-based medicine with support from the literature to optimize the functional return of athletes.
      From surgeons’ personal perspectives, we owe the success of patient care mostly to our rehabilitation colleagues; without them our interventions would never have reached their potential and athletes would not have scaled their pinnacle of performance. So, seek out your rehabilitation specialists and friends: physical and occupational therapists, massage therapists, athletic trainers, etc. Furthermore, we invite these specialists to submit future research to ASMAR. This team approach coupled with contemporary, research-supported rehabilitation protocols and techniques will aid patients’ return to optimal function not almost all of the time, but all of the time.

      References

      1. Paster E, Sayeg A, Armistead S, Feldman MD. Rehabilitation using a systematic and holistic approach for the injured athlete returning to sport. Arthrosc Sports Med Rehabil In press.

      2. Draovitch P, Patel S, Marrone W, Grundstein MJ, Grant R, Virgile A, Myslinski T, Bedi A, Bradley JP, Williams RJ III, Kelly B, Jones K. Return to sport clearance continuum is a novel approach towards return to sport and performance for the professional athlete. Arthrosc Sports Med Rehabil In press.

      3. Rhon DI, Tucker CJ. Nonoperative care including rehabilitation should be considered and clearly defined prior to elective orthopaedic surgery to maximize optimal outcomes. Arthrosc Sports Med Rehabil In press.

      4. Fares MY, Khachfe HH, Salhab HA, Bdeir A, Fares J, Baydoun H. Physical testing in sports rehabilitation: Implications on a potential return to sport. Arthrosc Sports Med Rehabil In press.

      5. Hedt C, McCulloch PC, Harris JD, Lambert BS. Blood flow restriction enhances rehabilitation and return to sport: The paradox of proximal performance. Arthrosc Sports Med Rehabil In press.

      6. Cognetti DJ, Sheean AJ, Owens JG. Blood flow restriction therapy and its use for rehabilitation and return to sport: Physiology, application and guidelines for implementation. Arthrosc Sports Med Rehabil In press.

      7. Gregory TJ, Rauchwarter S, Feldman MD. Rehabilitation using acute dry needling for injured athletes returning to sport and improving performance: Clinical commentary on the theoretical use of acute dry needling to aid in the recovery and performance of athletes. Arthrosc Sports Med Rehabil In press.

      8. Vincent HK, Madsen A, Vincent KR. Role of anti-gravity training in rehabilitation and return to sport after running injuries. Arthrosc Sports Med Rehabil In press.

      9. Gianakos AL, Abdelmoneim A, Kerkhoffs GM, Mulcahey MK. Rehabilitation and return to sport of women athletes. Arthrosc Sports Med Rehabil In press.

      10. Boudreau SL, Mattes LL, Lowenstein NA, Matzkin E, Wilcox RB. Customizing functional rehabilitation and return to sport in the female overhead athlete. Arthrosc Sports Med Rehabil In press.

      11. Vincent HK, Brownstein M, Vincent KR. Injury prevention, safe training techniques, rehabilitation, and return to sport intrail runners. Arthrosc Sports Med Rehabil In press.

      12. Rhon DI, Teyhen DS, Kiesel K, Shaffer SW, Goffar SL, Greenlee TA, Plisky PJ. Recovery, rehabilitation, and return to full duty in a military population after a recent injury: Differences between lower extremity and spine injuries. Arthrosc Sports Med Rehabil In press.

      13. Hohmann H, Pieterse R. Pilots following shoulder surgery and rehabilitation in a dedicated musculoskeletal rehabilitation unit of a major airline returned to work earlier when compared to standard rehabilitation by external providers. Arthrosc Sports Med Rehabil In press.

      14. Colbert L, Harrison C, Nuelle C. Rehabilitation in overhead athletes with thoracic outlet syndrome. Arthrosc Sports Med Rehabil In press.

      15. Campbell AM, Voight ML. Beyond the basics of athletic hip evaluation. Arthrosc Sports Med Rehabil In press.

      16. Ilizaliturri VM Jr, Zepeda Mora R, Rodriguez Vega LP. Rehabilitation after gluteus medius and minimus treatment. Arthrosc Sports Med Rehabil In press.

      17. Philippon MJ, Ryan M, Martin MB, Huard J. Capsulolabral adhesions after hip arthroscopy for the treatment of femoroacetabular impingement: Strategies during rehabilitation and return to sport to reduce the risk of revision. Arthrosc Sports Med Rehabil In press.

      18. Geeslin AG, Holling MJ, Miller ST. Rehabilitation and return to sport after arthroscopic treatment of femoroacetabular impingement: A review of the recent literature and discussion of advanced rehabilitation techniques for athletes. Arthrosc Sports Med Rehabil In press.

      19. Cunha J, Solomon DJ. ACL prehabilitation improves postoperative strength and motion and return to sport in athletes. Arthrosc Sports Med Rehabil In press.

      20. Badawy CR, Jan K, Beck EC, Fleet N, Taylor J, Ford K, Waterman BR. Contemporary principles for postoperative rehabilitation and return to sport for athletes undergoing anterior cruciate ligament reconstruction. Arthrosc Sports Med Rehabil In press.

      21. Gokeler A, Dingenen B, Hewett TE. Rehabilitation and return to sport testing after anterior cruciate ligament reconstruction: Where are we in 2021? Arthrosc Sports Med Rehabil In press.

      22. Waldron K, Brown M, Calderon A, Feldman M. Anterior cruciate ligament rehabilitation and return to sport: How fast is too fast? Arthrosc Sports Med Rehabil In press.

      23. Coquard M, Carrozzo A, Saithna A, Vigne G, Le Guen M, Fournier Y, Hager J-P, Vieira TD, Sonnery-Cottet B. Adding an anterolateral ligament reconstruction does not delay functional recovery after ACL reconstruction: A matched-paired analysis from the SANTI study group. Arthrosc Sports Med Rehabil In press.

      24. Matsuzaki Y, Chipman D, Hidalgo Perea S, Green DW. Unique considerations for the pediatric athlete during rehabilitation and return to sport following ACL reconstruction. Arthrosc Sports Med Rehabil In press.

      25. Nyland J, Pyle B. Self-identity and adolescent return to sports post-acl injury and rehabilitation: Will anyone listen? Arthrosc Sports Med Rehabil In press.

      26. Wagner KR, Kaiser JT, DeFroda SF, Meeker ZD, Cole BJ. Rehabilitation, restrictions, and return to sport after cartilage procedures. Arthrosc Sports Med Rehabil In press.

      27. Theisen BJ, Larson PD, Chambers CC. Optimizing rehabilitation and return to sport in athletes with anterior knee pain using a biomechanical perspective. Arthrosc Sports Med Rehabil In press.

      28. Lampros RE, Wiater AL, Tanaka MJ. Rehabilitation and return to sport after medial patellofemoral complex reconstruction. Arthrosc Sports Med Rehabil In press.

      29. Monson J, Schoenecker J, Schwery N, Palmer J, Rodriguez AP, LaPrade RF. Postoperative rehabilitation and return to sport following multi-ligament knee reconstruction. Arthrosc Sports Med Rehabil In press.

      30. Otley T, Myers M, Lau BC, Taylor DC. Return to sport following shoulder stabilization procedures: A criteria-based testing continuum to guide rehabilitation and inform return to play decision-making. Arthrosc Sports Med Rehabil In press.

      31. Oak SR, Klein B, Verma NN, Kerzner B, Fortier LM, Chava NS, Reinold MM, Bedi A. Rehabilitation and return to play of the athlete after an upper extremity injury. Arthrosc Sports Med Rehabil In press.

      32. Trasolini NA, Nicholson KF, Mylott J, Bullock GS, Hulburt TC, Waterman BR. Biomechanical analysis of the throwing athlete and its impact on return to sport. Arthrosc Sports Med Rehabil In press.