INTRODUCTION

Injuries are inevitable in heavy contact sports like football, hockey, rugby, and wrestling. Given the suddenness of many cases, it is no surprise that they can damage an athlete’s confidence, especially in relation to team social dynamics and athletic scholarships (4). Injured athletes also tend to suffer from greater anxiety than their non-athletic counterparts due to the cumulative pressure and stress surrounding athletics (3). This, combined with sleep deprivation, which is often observed in college athletics, is a recipe for mood disturbances, physiological decrements, and performance setbacks (2). Therefore, injured athletes must have access to organized, individualized, and progressive return-to-play programs, regardless of budgets. This article will examine a National Collegiate Athletic Association (NCAA) Division II football team’s unique and economical return-to-play progression, and aims to assist practitioners working in high school settings, smaller universities, or tactical organizations where limited resources are particularly common.

ESTABLISHING PROGRAM GOALS

As with anything, it is essential to start with the end in mind. Therefore, establishing return-to-play goals or mission tenets before programming is vital. After goals are set, they can be referenced whenever in doubt or during periodic reviews. The following principles directed return-to-play decision-making for the Division II program in discussion:

BENEDICT COLLEGE’S 2025 “MUSCLE BEACH” RETURN-TO-PLAY MISSION TENETS

1. Get to know the players
2. Educate the players
3. Train the players
4. Show the players they do not need “all the bells and whistles” to succeed
5. Return the players to their sport

These tenets were devised with a servant leadership mindset: one that serves the players, fosters camaraderie, and contributes to their development beyond sports. These tenets also served as a reminder that teaching athletes to manage their injuries through rehabilitation and clinical exercise is part of the healing process. From there, coordinated efforts toward player-focused initiatives can move forward.

CONSIDERATIONS FOR COMMUNICATION AMONGST STAFF MEMBERS

In sport and business, communication is vital. Therefore, athletic trainers, strength and conditioning coaches, and technical staff must work collectively to expedite injured athletes’ recovery. Additionally, practitioners must understand that eager athletes, for the sake of participation and perceived toughness, often underreport feelings of pain (3). Considering this, return-to-play communication should be targeted, efficient, and straightforward. If strength and conditioning coaches are not all on the same page, injured athletes could end up further straining themselves by performing multiple exercises or workouts per day. This could result in overtraining, increased recovery demands, and ultimately, athletes missing invaluable playing time.

To combat miscommunication, the sampled football team encourages non-practicing and injured athletes to lift weights alongside team practices under a strength and conditioning coach’s supervision. From there, the strength and conditioning coach and athletic training staff, who usually attend practices, can monitor the athletes’ safety in real time. Later, this article will provide specific cost-effective sample methods that can be used to work around injuries. The next section of this article describes injury classification as a prerequisite.

CLASSIFYING INJURIES AND ESTABLISHING CONSTRAINTS

Injuries can vary in location, nature, severity, and cause. Therefore, accurately categorizing them is imperative. The example football team classifies its injured athletes as full participation (FP), limited participation (LP), participation as tolerated (PAT), or no participation (NP). A de-identified snapshot of what this looks like is included in Figure 3. From there, the strength and conditioning coach, in collaboration with the sports medicine professional, further categorized athletes by using the following framework:

• • Short-Term Upper Body

» Jammed fingers, shoulder ailments, and sprained wrists

• • Short-Term Lower Body

» Sprained ankles, lower back pain, and turf toe

• • Long-Term Upper Body

» Upper body dislocations, bone breaks, and tears of grade 2 and 3

• • Long-Term Lower Body

» Lower body dislocations, bone breaks, and tears of grade 2 and 3

• • No Exercise

» Concussion, adverse cardiovascular conditions, bruised vital organs, and illness (viral or otherwise)

This list shows how strength and conditioning coaches can subcategorize injured athletes based on severity and estimated recovery time. From there, players who are temporarily out can perform exercises with their non-injured limbs until they learn to train on their own. This can free up much-needed time for strength and conditioning coaches who must develop specialized routines for more severely injured players. Tailored interventions like this can positively impact recovery time and physical function in injured athletes, so extra time allotted for such circumstances is invaluable (6). Figures 1 – 7 include examples of recycled equipment and modified exercises that were used to train injured football players. All athletes shown provided verbal consent to being photographed and are not related to the sample injury card included in this article.

THE OVERARCHING GOAL

The examples provided are simply small samples of the means that are used to return athletes to play as safely and as effectively as possible. As far as processes go, the aim is to get players ready for what they will encounter with sports medicine and their coaches in rehabilitation, the weight room, and at full-scale practices. For example, training the non-injured side may mitigate losses in strength and hypertrophy (6). This can be accomplished via progressive unilateral loading and will help players to maintain themselves in the weight room. Strength exercises performed on non-injured lower limbs may also help mitigate risk during sprint reconditioning. All in all, the goal is that players will graduate from return to play. Providing athletes with a positive atmosphere and an authentic support system in return to play facilitates player-administrator trust as word travels fast and peers take notice.

BONUS METHODS

Other special exercises used while working with this article’s model football team were inspired by both the military and Westside Barbell’s training methods. Figure 8 provides an example of a backpack added with weight and a makeshift towing sled. Rucking, a military-inspired practice of walking or hiking with added load, is a highly effective means of training strength and endurance that expends significantly more energy (1). Players occasionally used loaded backpacks to complete cost-effective workouts and intensify their climbs up the bleachers. From time to time, a similar Westside Barbell-inspired sled workout protocol was also employed. By using makeshift sleds comprised of weight plates and belt loops, non-practicing and injured players could perform long-duration sled tows using various techniques. Towing techniques included forward drags, backward drags for the quadriceps, lateral drags for the adductors, and power rowing for the upper body. These methods, paired with rucking, became a gritty trademark that helped market reconditioning, with positive affirmations from athletes due to their appearance and nature.

CONCLUDING REMARKS

Return-to-play methods are highly beneficial for injured athletes, yet it is oftentimes overlooked. Researchers discuss how exercise therapy among injured athletes can have long-term benefits beyond sport, describing how “attitudes, priorities, and perceptions of training-based activities appear to determine an important role in exercise engagement after injuries,” (7). With this, strength and conditioning coaches owe it to their athletes to develop robust return-to-play systems that restore athletes’ confidence and enable them to participate. This empowers athletes and promotes a “no excuses” winning atmosphere. In conclusion, return-to-play programs can help athletes and do not need to be costly. They should be incorporated at all levels of athletics and are a major asset for students.

This article originally appeared in NSCA Coach, a quarterly publication for NSCA Members that provides valuable takeaways for every level of strength and conditioning coach. You can find scientifically based articles specific to a wide variety of your athletes’ needs with Nutrition, Programming, and Youth columns. Read more articles from NSCA Coach »

Related Reading

Alvar, BA, Sell, K, and Deuster, PA. NSCA’s Essentials of Tactical Strength and Conditioning. Champaign, IL: Human Kinetics; 2017.