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Return-to-Play Decisions Involve More Than you Think

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Derrick Rose

After recent talks in Chicago, I realized there’s a lot of confusion surrounding the issue about when athletes can return to play after an injury.

Derrick Rose, the Chicago Bulls point guard, got the go-ahead from his physician to return to play after an ACL injury at the beginning of last year’s playoffs.

However, there’s no indication when he’ll actually play.

Today, I had the chance to speak with WAKR’s host Ray Horner about Derrick and other athletes.

The return-to-play decision is more than just a testament to whether that athlete is feeling better.

Athletes must go through what’s called functional testing to ensure that injury can sustain impact from the player’s sport. We don’t want to put a player on the field too early and risk the athlete re-injuring himself.

Below is a transcript and embedded audio player of our discussion.

Horner: With us live right now, 8:51 a.m., Dr. Joe Congeni from the Sports Medicine Center at Akron Children’s Hospital. And, Joe, when do we get back on the court or playing field? That’s what you want to address today.

Dr. Congeni: Yeah, we do, Ray. We talk a lot about return to play — you and I do. I know it’s confusing.

At the end of last week, I gave a couple talks in Chicago and it’s really confusing there in the case of Derrick Rose (Chicago Bulls point guard). That’s the case that kind of explains to people how these decisions are made.

If you remember about a year ago, he tore his ACL at the very beginning of the playoffs. We’ve seen people like Adrian Peterson (Minnesota Vikings running back) and others that have been back playing in 6 months, 7 months, 8 months.

[Adding to] the confusion with Derrick Rose, even his physician said the ACL is stable, the knee is stable, and he can return to play when he’s ready.

So, how do we find out when athletes are ready?

Dr. Joe Congeni

Dr. Joe Congeni

There’s a type of testing that’s called functional testing, Ray, where you have to put the knee through a lot of the same movement patterns — functional movements — that they’ll need to [perform] in the sport that they’re going back to.

So, it’s not like a day you just walk in the office and you say, “Hey, do you feel good today, Ray? Oh, okay, yeah, you feel okay? Okay, go ahead and play.”

We actually have to test these people and put them through similar movement patterns [they’d experience in] their game.

We get a lot of help from our sports physical therapists. There are different protocols out there where they’ll put people through box jumps and shuttle movements. I’ll even get kind of a report card on these athletes saying where they are functionally in the good knee versus the reconstructed knee, or the surgical knee, or the injured knee.

You may say, “Hey, what’s the big deal? I mean, in Chicago, they’re saying the surgeon said that Derrick Rose could play weeks ago. Why don’t you just put him out and see?”

Well, the big deal in an athlete like Derrick Rose, or we saw it earlier this year in RG3 (Robert Griffin III), is these are athletes with a very bright future. Do you want to send them back out there with a chance of re-injuring [themselves], especially in a postoperative knee — a knee that had surgery? Do you want to put them at risk?

So, this return-to-play decision is difficult. And, I just want people to know that we (medical professionals) do a lot, even in my office. I’ll do a lot of testing, functional testing, to see if the knee is ready to go through the function of their sport.

Horner: But, Joe, it seems like a case-by-case situation. We’re not talking head injuries here; we’re talking knees and joints and stuff. Is it a tolerance [thing] or is there a specific guideline, “chart,” that you go by?

Dr. Congeni: There is. You’re right. We’re not talking about brain injuries. With brain injuries, unfortunately, it’s very hard to test the brain because you actually are not going to take the same kind of hits and blows to the head.

But, from the standpoint of other joints, yes, you can put them through the same cutting and pivoting and movement. So, yes, there are specific protocols so you can compare the good side to the injured side, and you can compare to other athletes.

There are newer devices being tested now. A lot of these virtual reality tools, Ray — you know, the same concept as like the Wii — you would put people through movement patterns to see how they move laterally, one side to the other; stop and start; how to jump; jump off one leg, and those kinds of things. Virtual reality tools are being used in high-level cases to make decisions about when that joint is ready to return to play.

Horner: Alright, Joe, good stuff as always. Thanks for the education, my friend, and we’ll catch up with you again next week.

Dr. Congeni: Enjoy this great basketball weekend, Ray. Have a great week.

Horner: You too.

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About Dr. Joe Congeni - Director of Sports Medicine

Dr. Joe Congeni is the Director, Sports Medicine; Clinical Co-Director, Center for Orthopedics and Sports Medicine at Akron Children's Hospital. For the past 25 years, Dr. Congeni has been the “go to” source for national and local media looking for information about pediatric sports medicine.

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