When is it safe to return to sport after after a lower limb injury?

When athletes are rehabbing lower extremity injuries, a common question is, “when can I return to sport?”. The answer varies depending on a variety of factors, including the type of injury, the patient’s progress throughout their time in rehab, and several other factors.

First, let’s dive into some of the most common sporting injuries of the lower limbs. (Or, skip ahead in this article to learn when you’re ready to return to sport.)

What are some of the most common injuries of the lower limbs?

With 62 bones and literally hundreds of muscles in our lower limbs, injuries in that area are a common result of sport. The most common areas for injury in the lower body include, foot, ankle, shin, knee and thigh. At Release Physical therapy, we treat the following lower limb injuries most frequently:

Plantar Fasciitis
Plantar fasciitis is one of the most common foot injuries, and can occur as a result of many different sports. It is the inflammation of the Plantar fascia, the tissue that connects our heels to our toes, and occurs as a result of overuse, usually due to running or walking. Repeated stretching causes the tissue to tear, which results in painful inflammation that is worst when first getting up in the morning, or engaging in walking or running.

Anterior Ankle Impingement
More commonly known as footballer’s ankle, anterior ankle impingement is caused when bone spurs (protrusions along the bone edges) develop at the front of the ankle. This condition is commonly associated with football, as the kicking of the ball forces the ankle to its extremes. Over time, these spurs may rub against one another or the surrounding tissue, leading to pain and swelling.

Shin Splints
Shin splints often occur in people who are pushing themselves too hard, particularly if they are running as fast as they can, or uphill. There are two main categories of shin splints: anterior and posterior.

Anterior splints occur at the front of the legs, where your tendons attach to your shin bones, and mainly results in a dull ache that worsens if not given sufficient rest. Posterior splints occur where the tendons attach to the inner areas of your shin bones, and thus cause pain that can be felt deep inside the leg, often running all the way down to your feet. Shin splints are often symptomatic of a stress fracture, especially when there is considerable swelling involved.

About one-third of all skiing injuries are tears to the ACL (Anterior Cruciate Ligament) and the MCL (Medial Collateral Ligament), which are located at the front and side of the knee respectively. This is a common injury in skiers, especially new skiers, who make sharp turns too quickly.

Iliotibial Band Syndrome
Iliotibial Band Syndrome or “IT Band Syndrome” is another common overuse injury, and occurs most commonly in runners. Responsible for helping us maintain balance, the iliotibial band runs from our hips to our knees, and can become inflamed when push themselves too hard to increase the amount of distance they cover.

Runner’s Knee
Runner’s knee, also known as Chondromalacia Patella or Patellofemoral Pain Syndrome, is a common overuse injury in runners and cyclists. It is a result of the cartilage underneath the kneecap being gradually worn down, which can cause swelling, stiffness, and pain at the front of the knee, but can be treated with a combination of rest and stretches. (Side note: Running is one the most accessible and common forms of exercise. It is also one of the easiest ways to develop an injury. Consider a running assessment to keep you running injury-free.)

Quad Strain
The quad muscles are those located at the front of the thigh, and can become strained through overuse, failure to properly warm up before exercise, physical trauma, or even overstretching during a warmup. While some quad stains can result in severe pain, they usually result in a dull ache, and can be treated with a combination of rest and ice.

Stress Fractures
A stress fracture occurs when the outer layer of our bones are put under repeated stress, such as when our feet hit the ground during a run. The occur gradually, often as a result of too much exercise or footwear that is not shock-absorbant. Most stress fractures will result in a dull ache, and will require plenty of rest and calcium to heal properly.

Like Plantar fasciitis, tendonitis is the inflammation of one or more of your tendons. Tendonitis can occur in almost any of the body’s tendons, usually because it has been overworked. Repeated or excessive stretching of the tendon causes it to tear, which can result in swelling and a dull, achy pain. Rest and ice are the most effective ways to treat tendonitis, while stretching properly is the best way to prevent it. Be sure to check out our post about when to ice or heat your injury.

How does my physical therapist determine when I’m ready to get back in the game?

There are a number of tools that therapists can use to assess a patient’s readiness to return to sport. These tools help reduce the risk of re-injury and ensure that the patient is prepared for success.

At Release Physical Therapy, we believe there is no single approach to treating injuries. Our physical therapists offer a comprehensive and patient-centered approach across the entire treatment trajectory – from the initial assessment/diagnosis and rehabilitation program – to the post-rehab assessment and follow-up care. Even two patients with identical injuries will mostly likely not have identical care plans. Why? Put simply, it is because we treat the whole patient – not just the injury. We consider your lifestyle, activity level before your injury, your personal fitness goals, your history of injuries, and more.

In turn, your post-rehab assessment we will include a combination of tools that will help us determine when you’re ready to return to sport. These tools include hop testing, strength testing, mobility testing, and the athlete’s psychological readiness. Now, Let’s take a closer look at hop testing.

What is the hop test series?

One of the most common ways to assess a patient’s readiness for return to sport is through a series of hop tests. Throughout these tests, we will be comparing the affected, or injured side, to the unaffected side. The goal is to score at least 90% when comparing the affected side to the unaffected side. Detailed below are the hop tests your PT may ask you to perform to help determine your readiness to return to sport.

Single Hop Test
The goal of a single hop test is to jump as far as possible on one single leg, with a firm landing, without losing balance.

Single Hop Test
Single Hop Test

Triple Hop Test
The goal of the triple hop test is to jump as far as possible on one single leg, three consecutive times, with a firm landing and without losing balance.

Triple Hop Test
Triple Hop Test

Cross Over Hop Test
The goal of the cross over hop test is to jump as far as possible on one single leg, three consecutive times, with a firm landing and without losing balance. Each time the patient hops, they will be asked to cross a midline.

Six Meter Timed Hop Test
The goal of the six meter timed hop test is to jump six meters, as fast as possible, on one single leg as seen in the diagram below.

Hop Test Series
Hop Test Series

Summing it all up

Again, although these hop tests can assist us in determining an athlete’s readiness for return to sport, they will not be used alone. Other factors, such as strength testing, mobility testing, and the athlete’s psychological readiness, will also be considered.

Wondering if you are ready to return to sport after an injury? Schedule an initial evaluation with a physical therapist at Release Physical Therapy today!