Jun 22, 2026Return-to-play strategies after musculoskeletal injuries
Returning to play for athletes after a musculoskeletal injury involves a well-devised and properly planned progression that includes many professionals in the athletic field.
Musculoskeletal injuries refer to any type of extensive damage or trauma to the skeletal or muscular systems of the human body.
These injuries can arise from prolonged or extensive physical activity which subsequently results in injuries to bones, ligaments, tendons, joints or muscles. These injuries can result in swelling, pain and significant reduction of flexibility, mobility and stability to the affected areas.
Typically, these injuries are diagnosed by a clinical physician as tendonitis, sprains, strains, fractures or broken bones, and these diagnoses’ can be a result of chronic or acute damage.
On the way to returning to play, some professionals or subject matter experts (SMEs) that guide an athlete along the way can include variations of the following: doctors, physical/cognitive therapists, athletic trainers, mental performance coaches, strength and conditioning coaches, dieticians, family, friends and loved ones.
These SMEs deliver the guidance as a return-to-play continuum, which includes the recovery and rehabilitation of the affected areas or musculoskeletal injury. They also offer understanding of the principles of physical therapy, medication, strength and conditioning, mental performance and nutritional education. Each of these modalities plays an instrumental role.
Aside from the most recognizable SMEs mentioned above, the others provide the following: strength and conditioning coaches provide professional programming with aerobic and anaerobic conditioning based on exercise science principles; dieticians provide advice as to which micro- and macronutrients are essential to a recovery to either gain or lose the right kind of weight; and therapists or mental performance coaches can assist in reframing an athlete’s perceptions pursuant to their injury into how they can progress rapidly to help their team and themselves return to their best performance level.
Lastly, not only must an athlete be monitored closely, but if an athlete is returning to play after a reoccurring injury, more caution and additional safety measures must be considered to avoid an increased risk of injury because of their previous predisposition to that injury.
Components of return-to-play
Regardless of the sport, components that need to be considered for an athlete are whether he or she is participating, returning to play the sport or returning to perform.
Returning to sport could involve an athlete returning to the field of play but unable to perform or contribute the way they had prior to the injury.
With participation, an athlete might not be cleared medically (athletically or psychologically) to play on the field but is participating in drills at a lower level or at less than the desired goal. Returning to sport could involve an athlete returning to the field of play but unable to perform or contribute the way they had prior to the injury. Ultimately, a return to performance would be optimal as it involves returning to the sport at the level the athlete was at preinjury or, better yet, perform at a higher level.
Initially, the components include the healing phase of RICE, or rest, ice, compression and elevation, followed by the rehabilitative phase in which clinical staff comprised of the doctor and therapists prescribe exercises for building tendon, ligament and bone strength to enable range of motion.
Through their inherent nature, an athlete could want to return sooner than advised and this is where alternative exercises can be programmed, such as swimming or conditioning in water as it places minimal impact on the musculoskeletal system. This not only helps the rehab process but does so without the external loads or resistive forces put on the body.
Swimming provides aerobic and anaerobic benefits based on the duration and effort or intensity that is utilized. The subsequent component is the buildup of aerobic and anaerobic conditioning. This is where a strength and conditioning coach’s expertise comes into play as they assess, analyze and implement the correct progressive biomechanical (movement) assessments.
Furthermore, a strength coach can then prescribe the correct modalities or precise amounts of volume and intensity for anaerobic and aerobic conditioning. This is the time when a strength coach makes the assessment to properly program an athlete’s conditioning without placing undue stress on the musculoskeletal system and the specific injured body part.
Once the conditioning is met or sufficient, an athlete can then begin working on their athletic skill set.
Once the conditioning is met or sufficient, an athlete can then begin working on their athletic skill set, whether it be fielding ground balls in baseball, dribbling a basketball or practicing skating skills for hockey. Here, a strength coach has considerable input on load management for the athlete not only for return to play but also to monitor the load programmed to ensure the previous injury does not reoccur or the presence of a new musculoskeletal injury does not emerge.
It is at this time, if possible, a dietician can be implemented to assist an athlete in weight gain or weight loss depending on what transpired during the injury. Additionally, a dietician can provide nutritional support which will aid an athlete as to which macronutrients (protein, carbohydrates and fats) and micronutrients (vitamins and minerals) should be properly dosed for optimal athletic performance.
Lastly, the use of a mental performance coach can provide excellent opportunities because the setback in an athlete’s rehabilitative process does not just include the physical side, but includes mental components as well. An SME in this field is able to assist an athlete not only in focusing on their return to play but also in reframing an athlete’s feelings, emotions and outlook as to how their time off affected them. Also, athletes may feel indebted to their team for not being present during their season and a mental performance coach has the psychological toolset to help the athlete in this matter.
