PT/ATC Students often find themselves at a crossroads when planning to return to sports programs. As a profession we often rely on measurement tools and tests to gauge an athlete's recovery, but how accurately can we predict their future performance?

Underestimating uncertainty when working with athletes/patients can lead to unrealistic plans. Athletes/patients might be pushed too quickly through rehabilitation or burdened with performance expectations that are either too high or too low. We often focus solely on measurable factors while overlooking the intricate interplay of psychological and contextual elements. We tend to rely on our "gut instincts" rather than a thoughtful assessment of uncertainty.

To make better return to sports decisions, we must abandon simplistic, black-and-white views and instead embrace complexity. Here's how:

1️⃣ Leverage Research Trends: Start by considering trends and patterns from injury epidemiology research. This valuable information informs our general protocols and procedures, offering us a solid starting point.

2️⃣ Evidence-Based Approach: Utilize the best available research evidence to analyze each athlete's unique case. This ensures that we tap into the current knowledge landscape and make informed decisions.

3️⃣ Identify and Categorize Uncertainty: Take the critical step of identifying areas of uncertainty and categorizing them into levels based on the degree of uncertainty. This structured approach helps you effectively tailor your strategies and interventions to address specific uncertainties.

For Example:

Level 1 (Low Uncertainty):

• Adherence to a gradual return to sports protocols after injury. Research clearly shows that gradually increasing activity levels reduces re-injury risk. So implementing and monitoring a graded progression is straightforward based on evidence.

• Restoring range of motion/flexibility after immobilization. If the range of motion is impaired, the evidence clearly supports targeted mobility work. Simple to address with low uncertainty.

Level 2 (Moderate Uncertainty):

• Psychological readiness to return after a major injury. Harder to predict when an athlete will truly feel confident to return. Could monitor mindfulness, and coping skills as discrete possibilities.

• Aerobic conditioning status after time off. Many factors influence the exact return of fitness after a layoff. Can test discrete outcomes like VO2max, lactate threshold, etc. but uncertainties in how these translate to performance.

Level 3 - High uncertainty factors with multiple, unpredictable outcomes.

• Carryover of rehab exercises to sports performance. Unclear how gains in isolated rehab translate to dynamic sports movements.

• Cumulative workload capacity after time away. Difficult to gauge how much cumulative load an athlete can handle upon return.

Level 4 - Very high uncertainty with little evidence available

• Career longevity and performance after injury. Extremely difficult to predict career trajectory and the impact of injury over many years.

• Genetic/epigenetic contributors. How genetic and epigenetic markers interact with injury is very unclear currently.

Remember, each athlete's journey is as unique as their fingerprint. 🏅 

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