Return to Sport Testing at Mangiarelli Rehabilitation
Return to sport testing is critical to ensure that an athlete is ready to return to competition and to prevent future re-injury. Return to sport testing is most commonly performed after ACL reconstruction and rehabilitation. At Mangiarelli Rehabilitation, our sports medicine physical therapists provide a thorough, evidence-based functional return to sport test for athletes of all ages. Check out our video below to learn more about the return to sport testing process after ACL rehabilitation at our clinic!
What is Return to Sport Testing?
Functional return to sport (RTS) testing objectively measures an athlete’s progress and helps to determine the effectiveness of rehabilitation and when the athlete can safely return to sport without the risk of injury. To safely return to sport, the athlete must return to prior function in functional movement patterns, muscle flexibility, strength, power, endurance, aerobic and anaerobic conditioning, speed and agility, and balance and proprioception.
The physical therapist tests different categories to assess return to sport readiness and function:
Strength and joint stability by testing single-leg-based skills and activities, like hop tests, that require dynamic joint stability that require the athlete’s balance and proprioception.
Speed, agility, and coordination through activities that stress the athlete’s ability to execute a complex movement pattern in a short period of time or quickly change direction and cut, jump, or pivot.
Plyometric activities that stress the ability to load, jump, and land and require quick powerful movements to improve lower extremity dynamic control.
Running mechanic evaluation such that running mechanics are normalized to the types of running, sprinting, and cutting the sport requires.
Research supports that returning to sport should be based on meeting key performance criteria, not allowing the patient to return to sport purely based on timeframe or clearance by the orthopedic surgeon. The ideal return to sport protocol would include clearance by the orthopedic surgeon and successfully passing return to sport testing with the physical therapist.
A 2016 study assessed 106 athletes who had recently had ACL surgery and were required to pass five key return-to-sport performance criteria (quadriceps strength within 10% of the uninjured side and 4 single-leg hop tests with no more than 10% difference between sides). Thirty-eight percent of athletes who returned to sport despite not passing the RTS criteria re-injured the ACL; of the 38%, 39% of them re-injured when they returned to sport earlier than 9 months and 19% reinjured when they returned to sport after 9 months. Only 5% of athletes who did meet the RTS criteria re-injured the ACL. The research indicated that for every one-month delay in return to sport, the re-injury rate was reduced by 51%.
Return to Sport Testing at Mangiarelli Rehabilitation
Mangiarelli Rehabilitation physical therapist Mike explains the process of return to sport testing after ACL reconstruction and rehabilitation at our physical therapy clinic. ACL rehabilitation at our clinic generally spans nine months to a year of physical therapy before the athlete is cleared using our RTS testing protocol to return to sport.
The first step of the return to sport testing protocol at our clinic begins with the use of our BTE Primus RS objective testing equipment to test isometric strength, including extension and flexion; the therapist places the knee at 30 degrees, which protects the ACL during the test. We first test the non-affected leg and then compare it to the affected leg. If the athlete scores within 5% of the non-affected leg with the affected leg, then they pass and can move along to the next phase of the test. If the athlete does not pass, the test stops, and the therapist and athlete continue to strengthen the affected leg during rehabilitation before testing again.
The second step of the RTS testing protocol is the jump or hop test, which is completed on our clinic’s Astroturf. The therapist lays out a tape measurer to determine distance and has the athlete do a two-footed jump with landing on one foot, the first hop landing on the unaffected leg and then second, landing on the affected leg. The athlete gets two attempts. If the athlete’s landing is not stable, the athlete does not pass the test. The athlete must be stable on every landing.
If passed, the athlete progresses to a single-foot hop test with a one-footed landing, first the unaffected leg and then the affected leg. Measurements are taken and comparisons are made between the affected and unaffected leg. The next hop test involves a one-footed three-hop test with single-leg landing and then a crossover single-leg hop with single-leg landing. The affected leg results after the hop tests must be within 5% of the unaffected leg results to pass this phase of the test. The athlete must show that he or she has good proprioceptive control and the ability to balance themselves after each landing of the hop tests before being allowed to return to sport.
The last stage of the RTS testing protocol is a running mechanic test using cones on the Astroturf. Initially, the athlete completes a 5-10-5 shuttle run between the cones along the length of the turf. The athlete should be within two-tenths of a second going each way. Then the athlete does an entire shuttle circuit that must be completed within 20 seconds. The athlete runs down the length of the turf, then back peddles, then turns right into a shuffle run (there and back), and then a carry-open run (there and back), and lastly, a full sprint up and down the length of the Astroturf. If they complete that shuttle circuit within 20 seconds, they have completed and passed the RTS protocol. After passing this evidence-based and safe RTS protocol, the athlete is the safest they can be to return to sport and minimize the risk of re-tear of the ACL.
