There is a sports cliché I love: “The most important ability in a player is availABILITY.”
Injuries and the recovery from those unfortunate events are a coaching nightmare. You never want to be without your key players, but injuries are inevitable in nearly every sport. Return-to-play is a big topic, one that many coaches don’t always have self-confidence about when line-up decisions need to be made.
If you are a few credits shy of your medical degree, here are three key concepts that can boost your knowledge of injuries and help you establish some return-to-play criteria that will have your squad competing at top efficiency:
- Understand the injury timeline to structure your own return-to-play criteria
- Educate your players about what “data” you’ll be collecting during their return-to-play process
- Manage your roster when reactivating players, giving consideration to both the physiological and the psychological impact of an injury
UNDERSTAND THE INJURY TIMELINE
Fostering good communication among all the interested parties is challenging when trying to establish a workable timeline in an injured athlete case. Often there is a medical doctor overseeing the case, but the day-to-day work is done by the athlete and various rehab professionals. As a coach, you are right to put faith in these individuals to do what is best for players, but you might not fully understand what goes into the daily grind.
“Return-to-play criteria” (RTP) is the most accepted term for this process. There are five things to consider in common hockey injuries (concussion not included), depending on the severity, when trying to establish your criteria:
- Joint range-of-motion needs to be adequate, moving toward optimal. These sport-specific motions should be pain-free.
- Any special/clinical testing (challenging the damaged tissue) should be within normal limits (as defined by a medical/rehab professional). This is likely the phase in which the player returns to the ice in limited capacity.
- Sport-specific movements(on-ice) should be performed pain-free.
- Sport-specific movements (on-ice) should be performed at full speed.
- The player has full confidence in their ability to compete in the sport (as defined by the player and the coach).
(Take a closer look at the rehab process)
EDUCATE YOUR PLAYERS
Once you have spent some time and thought establishing a criteria for what you want to see from players before adding them back to the line-up after an injury, educate those players as to what types of information (data) they should be gathering from their day-to-day efforts.
If the only question they ever get is about their pain, then players become focused only on pain and they assume that absence of pain is the key factor to getting back on the ice. In this pain-focused environment, we run the risk of developing “fear avoidance behavior” in athletes. Experiencing pain can trigger a fear reaction, especially if that pain is standing in the way of peak performance and achieving goals. This fear reaction can lead to avoidance of the activity entirely, neither a psychologically nor a physiologically safe environment for an athlete.
It’s important to fully engage players in their recovery and to teach them to appreciate the process. Point out a few aspects of a player’s game that could be impacted by the injury (shooting, skating, contact). Have the player try a few things on their own before they return to full team practice. Ask them to collect data on these things and establish what they can or cannot do at this time. Offer encouragement and praise for the progress and offer ways to improve weaknesses. Interacting in this way with the player will help actively engage them in the process, increase their self-efficacy and may even help find solutions by listening to their feedback.
MANAGE YOUR ROSTER
There are many approaches to reactivating a player into the line-up. My personal perspective is through the lens of tissue injury and recovery. While in the game of hockey this approach is very uncommon, I think it is highly advisable to consider this point of view. Back-to-back games should be limited when coming back from injury. Three consecutive practices without a recovery day is too much in this same scenario. In my experience, managing output/workload is a difference maker especially with injuries to the hip, groin and knee. A one-game-on, one-game-off strategy is a good way to expose a player to game situations and respect the natural tissue healing cycle.
Admittedly, there are times when external factors influence such decisions and may override tissue health considerations. If both coach and player are on board with a more aggressive approach, the best advice is to always listen to the medical professionals for safe parameters. The reality is that negligence can be very common in this phase. Managing a player’s minutes and being attentive to “getting cold” are all things that fall on the bench boss during the game. Having a set game plan going in will eliminate hasty or emotional decision-making but, more importantly, doing so ensures that everyone involved knows what the ultimate goal is, that is to empower the individual.
Consider this real-world approach to a player re-entering the line-up after a mid-season groin injury:
Pregame
- Establish a rough estimate of playing time to set expectations and identify key performance habits. Place emphasis on hydration, fueling and warm-up strategies.
- Agree on contingencies if conditions start to change such as during long breaks (PK/PP) jump on ice between whistles and stay warm; create signals for the coach if something is wrong; check in with the trainer between periods.
Game time
- Maintain focus on key performance habits.
- Establish the difference between pain versus performance. Remember that some shifts may have pain, but not all pain inhibits performance. Emphasize that it is okay to be sore, but it is not okay to be limited by pain, impacting your team.
Using this process becomes the framework for how you handle injury in the future. Having experience and establishing a specific game plan make the process less stressful.
Aside from specific game strategies, the methods by which the coach communicates with the injured athlete can set a tone that leans into full recovery, both mental and physical. The conversations can come in phases with an emphasis on questioning and the use of active listening to the athlete’s responses. Notice the language this coach uses with an athlete who’s coming back from a shoulder injury (and note the avoidance of a specific focus on “pain”):
Phase 1
- “How are you liking the rehab place you are going to?”
- “How is your range of motion coming along?”
- “Which of your recovery strategies seems to be having the most impact?”
Phase 2
- “What does the doc have to say about your progress?”
- “Is there anything you need from me?”
This is likely the phase in which you may be able to get the player back on the ice in limited capacity. This is a good place to be as a player and as a coach. Very rarely will an injured player hear the words “Is there anything you need from me?” from a head coach and, yet, it could be something so simple and impactful. Really listen to players in these moments and pay attention to their body language. If the two do not match, do not buy what they are selling. An upbeat response delivered with a defeated body posture is probably a lie, a misguided effort to please the coach and get back in the action. Conversations like this reassure the player that you are looking out for their best interest as a human in addition to providing an opportunity to gather some intel as to how the medical professionals are treating your athletes.
Phase 3
- “Glad to see you back on the rink.”
- “Let’s do some skating drills and see how that impacts your shoulder.”
This is when the player development mentality can kick in. You will be collecting data in the session to determine what skill you can target with your skating drills and whether you can advance to using on-ice strategies for conditioning. A sample progression might look like: passing > shooting > stick contact > low impact contact leading into non-contact team practice followed by full-contact team practice.
Phase 4
- “You are looking good out there.”
- “ Tell me how you feel when…” (drill down on specifics)
In this phase, you can ask more position specific questions: face-offs, one timers, net front battle, etc. Get the info you, as the coach, need to make a solid line-up based decision. It is likely your players will just want to play; remember, you manage the roster for maximum team performance.
Dr. Gary’s Game Plan – The Big Takeaway
For professionals like me, the return-to-play process IS the game. Maximizing this process is where I derive my personal passion for helping players; it’s how I fulfill my goal to use my skill set to be an asset to the teams that I work with and to make the game a better experience for the athletes who play it. Just like in sport, when skill sets are equal, communication is the difference maker. We must help players avoid the fear of injury! The final step in basic return-to-play guidelines is knowing the player is psychologically ready for competition.
As a coach (or supportive parent), you may have a bigger impact in this process than you think. Pain and injury can be incredibly stressful for players at any level and for a multitude of reasons; this is the human side of athletics. In an injury scenario, a player will be getting advice from many sources. It is critical that we try to influence the language being used around the player. If the communication creates fear or doubt in the player’s mind, everything will be more difficult in the recovery process.
If possible, surround your players with medical and rehab professionals that understand the sport of hockey or at least sports in general. In most cases, sport-focused professionals are more selective in their language and can help foster confidence in the player by avoiding an emphasis on pain and putting more emphasis on the process.
