How Do We Prevent Injuries?
Assessing return to sport and injury prevention models
The Dreaded Injury Prone Tag


The difference between ‘Return to Sport’ and ‘Return to Practice’
- Return to participation (RTPa): The athlete may be participating in rehabilitation, training (modified or unrestricted), or sport, but at a level lower than his or her RTS goal. The athlete is physically active, but not yet ‘ready’ (medically, physically and/or psychologically) to RTS. It is possible to train to perform, but this does not automatically mean RTS.
- RTS: The athlete has returned to his or her defend sport but is not performing at his or her desired performance level. Some athletes may be satisfied with reaching this stage, and this can represent successful RTS for that individual.
- Return to performance (RTPf): This phase is an extension of the RTS phase. The athlete has returned to his or her defend sport and is performing at or above his or her pre-injury level. For some athletes, this stage may be characterized by personal best performance or expected personal growth as it relates to performance.
Professional Athletes Are Not The Standard

Comprehensive return to play assessment

The evolution of injury prevention

Meeuwisse (1994) Figure 2. No copyright infringement is intended.

McIntosh (2005) Figure 1. No copyright infringement is intended.

Bahr and Krosshaug (2005) Figure 3. No copyright infringement is intended.
Summary and Recommendations for Injury Prevention and Return to Sport
Regarding sports injuries, the athlete should be analyzed as a complex system and the research focus would be on how relationships between units (i.e. biomechanical, behavioral, physiological and psychological) give rise to the collective behavior of the athlete and how the athlete interacts and forms stable relationships (regularities) with his/her environment.

References
- Ardern, C.L., et al., 2016 Consensus statement on return to sport from the First World Congress in Sports Physical Therapy, Bern. Br J Sports Med, 2016. 50(14): p. 853-64.
- Tassignon, B., et al., Criteria-Based Return to Sport Decision-Making Following Lateral Ankle Sprain Injury: a Systematic Review and Narrative Synthesis. Sports Med, 2019. 49(4): p. 601-619.
- Lauersen, J.B., D.M. Bertelsen, and L.B. Andersen, The effectiveness of exercise interventions to prevent sports injuries: a systematic review and meta-analysis of randomised controlled trials. Br J Sports Med, 2014. 48(11): p. 871-7.
- van Mechelen, W., H. Hlobil, and H.C. Kemper, Incidence, severity, aetiology and prevention of sports injuries. A review of concepts. Sports Med, 1992. 14(2): p. 82-99.
- Meeuwisse, W.H., et al., A dynamic model of etiology in sport injury: the recursive nature of risk and causation. Clin J Sport Med, 2007. 17(3): p. 215-9.
- McIntosh, A.S., Risk compensation, motivation, injuries, and biomechanics in competitive sport. Br J Sports Med, 2005. 39(1): p. 2-3.
- Bahr, R. and T. Krosshaug, Understanding injury mechanisms: a key component of preventing injuries in sport. Br J Sports Med, 2005. 39(6): p. 324-9.
- Bittencourt, N.F.N., et al., Complex systems approach for sports injuries: moving from risk factor identification to injury pattern recognition-narrative review and new concept. Br J Sports Med, 2016. 50(21): p. 1309-1314.
- Ristolainen, L., et al., Gender differences in sport injury risk and types of inju-ries: a retrospective twelve-month study on cross-country skiers, swimmers, long-distance runners and soccer players. J Sports Sci Med, 2009. 8(3): p. 443-51.
- Fong, C.M., et al., Ankle-dorsiflexion range of motion and landing biomechanics. J Athl Train, 2011. 46(1): p. 5-10.
ABOUT THE AUTHOR

Zach has numerous research publications in peer-reviewed rehabilitation and medical journals. He has developed and taught weekend continuing education courses in the areas of plan of care development, exercise prescription, pain science, and nutrition. He has presented full education sessions at APTA NEXT conference and ACRM, PTAG, and FOTO annual conferences multiple platforms sessions and posters at CSM.
Zach is an active member of the Orthopedic and Research sections of the American Physical Therapy Association and the Physical Therapy Association of Georgia. He currently served on the APTA Science and Practice Affairs Committee and the PTAG Barney Poole Leadership Academy.