Testing Functional Performance Before Return to Sport

Functional training, or as I like to call it, sport specific training, involves training and stressing different body tissues in the way they are stressed in the athlete’s specific sport.

Returning to activity, or for athletes returning to sport, after an injury is an important topic in sports performance and rehabilitation. It is a topic that has been studied since athletes first sustained injuries in modern sports and is unlikely to stop being studied anytime soon. This is because there is currently no universally accepted valid and reliable sport specific test used by clinicians in rehabilitation.

In this blog post I will expand on the topic of important general activities that should be trained and tested before returning to sport and highlight the need to also test sport specific activities before returning to sport.

Sport specific activities are important to stress before returning to sport and must be trained, specifically after lower extremity injuries, to safely return to sport, to avoid re-injury, delayed return to sport, or other complications.

In most cases, performance based training and testing can begin after the initial stages of rehabilitation are successfully completed. This means that lower level activities can be tolerated at this stage without swelling, pain, or discomfort before, during and after exercise.

The following functional performance test categories are used by clinicians to evaluate the athlete’s readiness to return safely to sport, as well as to assess lower extremity function. Furthermore these testing categories can give us insight into which skills the athlete needs to correct and improve upon:

1. Strength and joint stability: Most often activities that test single leg based skills, such as squatting, to asses general strength and joint stability.
   
2. Joint stability: Dynamic joint stability activities that stress two systems, the proprioception system and the balance system. Proprioception is the ability of a joint to determine position in space and the ability to detect fine movement, while balance is the ability to preserve the center of gravity over the base of support. In most sports, deficiencies in one or both of these systems will result in an injury as unwanted movement will occur.
   
3. Speed, agility and coordination: These are activities that stress the athlete’s ability to develop complex movement patterns in a short period of time, to quickly change direction and cut, and for the athlete’s nervous system and musculoskeletal system to work together to prevent injury while cutting, jumping or pivoting.
   
4. Plyometric: These are activities that stress the athlete’s ability to load, jump and land. They include quick and powerful movements and are used to improve lower extremity dynamic control. In addition, these activities will prepare the neuromuscular system to deal with rapid changes in movement and increased joint forces as needed in various sports.
   
5. Running: Each sport may demand different types of running, sprinting and cutting, therefore the athlete’s  running mechanics should be assessed and normalized as needed. In some sports, such as football and lacrosse, activities such as running with several starts and stops should be stressed to mimic the sport’s specific running needs.
   

Training progressively to achieve harmony between these categories is needed starting with general activities and ending with sport specific activities under fatiguing conditions to account for the demands of the sport.

The Advanced Lower Extremity Sports Assessment (ALESA) is one of the tools that I and many other professionals use to target functional deficits in athletes who want to return to sport after lower extremity injuries. Rather than using this tool as a standard protocol to guide me, I use this assessment tool to gain further insight into the athlete’s quality of movement as it relates to the specific needs of the sport, taking into account all of the aforementioned test categories.