Sports medicine team

The sports medicine team provides health care services with the athlete’s needs and concerns as the primary focus. Key members and roles include:

• Team physician: Provides medical care and oversees the rehabilitation process. May be a medical doctor (MD) or doctor of osteopathy (DO), with specialization in various fields. Responsible for medical diagnosis, return-to-play decisions, and coordinating care.

• Athletic trainer (ATC): Responsible for day-to-day health care, injury evaluation, therapeutic exercise, and coordination with other professionals. Typically works in schools, clinics, or professional teams.

• Physical therapist (PT): Specializes in reducing pain and restoring function. May be board-certified in sports (SCS). Works in clinics or professional settings, assisting with rehabilitation strategies.

• Strength and conditioning professional: Focuses on strength, power, and performance enhancement. Plays a critical role in communication and reconditioning program design.

• Exercise physiologist: Provides expertise in exercise prescription based on metabolism and healing response.

• Nutritionist: Helps manage the healing process through proper nutrition. May be a registered dietitian (RD).

• Psychiatrist/psychologist: Supports mental health and coping strategies for injured athletes.

Types of injury

Injuries are often grouped into two broad categories: macrotrauma (a single, sudden event) and microtrauma (repetitive stress over time).

Macrotrauma: A sudden, acute injury caused by a specific overload event (e.g., a fall or collision). Examples include:

• Fracture: Break in the bone (can be open or closed, displaced or nondisplaced).

• Dislocation: Complete displacement of joint surfaces.

• Subluxation: Partial displacement of joint surfaces.

• Sprain: Injury to ligaments; graded as:

  • First degree: Minimal instability.

  • Second degree: Partial tear with minor instability.

  • Third degree: Complete tear with joint instability.

• Contusion: Bruise caused by direct trauma and blood accumulation.

• Strain: Injury to muscle or tendon; graded as:

  • First degree: Partial tear, painful but strong.

  • Second degree: Partial tear, weak and painful.

  • Third degree: Complete tear, very weak and painless.

Microtrauma: Chronic or overuse injuries caused by repetitive stress without sufficient recovery. Contributing factors include:

• Training errors (volume, technique, surface)
• Poor motor control or biomechanics
• Skeletal misalignment or flexibility issues
• Common injuries: Tendonitis and stress fractures

Sample forms for rehabilitation communication

These forms help the sports medicine team stay aligned on what the athlete can and can’t do during rehabilitation.

Includes:

• Injury date and diagnosis (e.g., ACL reconstruction)
• Clearance for specific exercises (e.g., stationary bike, single-leg hip)
• Contraindications (e.g., leg extensions, plyometrics)

Key principles of rehabilitation

1. Do not overstress healing tissue: Progress must respect the body’s natural recovery time and limits.
2. Fulfill specific criteria before progressing: Athletes must meet readiness benchmarks before moving to more advanced rehab stages.
3. Use evidence-based protocols: Programs should reflect current clinical and scientific findings.
4. Customize to individual needs: Consider the athlete’s sport, position, and specific injury for optimal recovery.
5. Use a team-based approach: Effective rehab requires coordination among all members of the sports medicine team.

Communication and coordination

• Ongoing communication is vital between athletic trainers, physicians, therapists, psychologists, nutritionists, and strength and conditioning coaches.

• Weekly meetings allow for review of injury status, exercise updates, and any necessary restrictions or program adjustments.

• Understanding indications (appropriate treatments/exercises) and contraindications (activities that may harm recovery) is essential for safe progression.

• Example:

  • Indication: Lateral shoulder strengthening post-dislocation.
  • Contraindication: Overhead pressing for an athlete with shoulder instability.

Phases of tissue healing

Rehabilitation planning is built around how tissue heals over time. Each phase has typical timelines, key biological events, and training priorities.

1. Inflammatory response phase

• Initial reaction to injury (pain, swelling, redness)

• Duration: ~2-3 days post-injury

• Key events:

  • Increased inflammatory cells
  • Decreased collagen synthesis
  • Edema restricts tissue function
  • Goal: Prevent disruption and allow phagocytosis (clean-up)

2. Fibroblastic repair phase

• Begins after inflammation ends; may last up to 2 months

• Key events:

  • Collagen fiber production increases
  • Decrease in inflammatory cells
  • Weak collagen laid down

• Goal: Prevent atrophy, promote new tissue formation

• Caution: Too much or too little stress can hinder healing

3. Maturation-remodeling phase

• Tissue transitions to stronger Type I collagen

• Duration: Several months to years

• Key events:

  • Proper fiber alignment
  • Increased tissue strength

• Goal: Optimize tissue function, safely return to activity

• Focus: Progressive overload with sport-specific demands

Tissue healing summary

Phase	Key characteristics
Inflammatory response	Pain, swelling, redness; ↑ inflammatory cells
Fibroblastic repair	Collagen production; ↓ inflammation
Maturation-remodeling	Proper fiber alignment; ↑ tissue strength

Goals of rehabilitation and reconditioning

• Heal tissues without overstressing them.
• Meet criteria to progress from one phase to the next.
• Use clinical research to guide program design.
• Collaborate with all professionals on the sports medicine team.
• Prepare athlete to return safely and effectively to full activity.

Exercise strategies during rehabilitation phases

General considerations:

• Goal: Restore strength, mobility, and function without reinjury.
• Programs should match the healing phase and injury location.
• Choose exercises that avoid aggravating injured structures.

Inflammatory phase strategies:

• Goals: Protect tissue, reduce inflammation, and avoid pain.

• Techniques:

  • Passive modalities (ice, compression, elevation, etc.)
  • Avoid exercise that stresses the injury site
  • If approved, gentle isometric contractions may be introduced

Fibroblastic repair phase strategies:

• Goals: Prevent muscle atrophy, restore neuromuscular control

• Exercises:

  • Isometrics: Submaximal contractions to maintain function
  • Isotonics: Light resistance, progress gradually
  • Cardiovascular work for uninvolved limbs
  • Active ROM and isolated movements proximal/distal to injury
  • Avoid multi-joint or joint-specific overloading

Maturation-remodeling phase strategies:

• Goals: Increase strength, realign fibers, prepare for return to sport

• Exercises:

  • Progressive overload with advanced sport-specific drills
  • Eccentric and concentric exercises to stress new tissue
  • Neuromuscular control drills (e.g., balance boards, visual deprivation)
  • Return-to-play testing based on functional benchmarks

Neuromuscular control:

• Critical for injury prevention and performance

• Exercises include:

  • Mini trampolines, stability balls, uneven surfaces
  • Progressions with eyes closed to remove visual reliance
  • Activities like squats/push-ups on unstable ground

Advanced exercise strategies

• Functional training must reflect sport-specific demands. Movements should mirror the joint angles, velocities, and force outputs of the sport.

• Progress from:

  • Basic balance and strength exercises (e.g., static holds, single-leg stance)
  • To dynamic, sport-specific movements (e.g., sprinting, plyos, change of direction)

• Example: A basketball player with an ankle sprain progresses from walking drills to full sprints and sport-specific movement.

Kinetic chain concepts

• Closed kinetic chain exercises: Distal segment is fixed (e.g., squats, push-ups); often more functional and joint-stabilizing.
• Open kinetic chain exercises: Distal segment is free (e.g., leg extension); useful for isolated muscle strengthening.
• Most sport movements combine both (e.g., sprinting involves open and closed elements).

Goals by rehab phase

Phase	Primary goals
Inflammatory response	Protect tissue, prevent new damage, no active movement of injured area
Fibroblastic repair	Prevent atrophy, maintain function, use light isometrics, proprioceptive drills
Maturation-remodeling	Optimize function, progressively load tissue, include joint-specific & velocity drills

Program design and resistance training

• Follow the same structure as healthy athletes (progressive overload, SAID principle)

• Popular resistance models:

  • DeLorme: Progressive increase (50% → 75% → 100% 10RM)

  • Oxford: Reverse progression (100% → 75% → 50%)

  • DAPRE (Daily Adjustable Progressive Resistance Exercise):

    • Adjust load based on performance in set 3

Aerobic and anaerobic training

• Consider sport-specific metabolic demands:

  • Marathon runner = endurance-based recovery
  • Olympic lifter = power and strength emphasis

• Use modalities like:

  • Upper body ergometers
  • Deep water running
  • Stationary cycling, elliptical

• Modify for uninjured limbs during recovery phase

Application of resistance training design (table summary)

Phase of healing	Design variables	Marathon runner	Olympic lifter
Inflammatory response phase	Goals/exercises	No quad activity, rest, maintain strength in other areas	Same as runner, maintain upper body and power
Fibroblastic repair phase	Goals/exercises	Start isometrics, add pain-free isotonic exercises, introduce aerobic work	Begin quad strengthening, consult with sports med team, continue upper body/power work
	Sets/reps/intensity	2-3 sets, 15-20 reps, <50% 1RM	3-4 sets, 8-10 reps, <50% 1RM
Maturation-remodeling phase	Goals/exercises	Start sport-specific drills, gradually increase load and ROM	Add dynamic lifts (e.g., squats, RDLs), progress movement to match sport
	Sets/reps/intensity	2-3 sets, 15-20 reps, increase to >75% 1RM	3-4 sets, 8-10 reps, increase to maximal intensity (>75% 1RM)

Reducing injury risk

• Previous injury is the strongest predictor of future injury.

• Programs must be:

  • Sport-specific
  • Focused on neuromuscular control during landing, jumping, and cutting
  • Include single-leg strength work