Like all student-athletes, coaches and families, I was excited about the Illinois High School Association’s (IHSA) recent announcement of a return to high school sports. The number of COVID-19 cases, hospitalization and positive tests have steadily decreased throughout the state of Illinois, placing all regions into “Phase 4” and allowing the return of practices and competitions for all sports at all risk levels. There are clear benefits for the student-athlete with the return to sports, including improvements in their physical, mental and emotional health.
Despite all this positive news, it is important to realize that we are still in the middle of a pandemic. All of the strategies that have been encouraged to prevent COVID-19 infection must continue, including mask wearing, social distancing, hand washing and limiting crowds, particularly in indoor settings. Coaches will have to get creative in their practice plans to maintain these restrictions, however it provides a great opportunity to focus on fundamentals and individual skill development. Athletic teams should still be performing daily temperature and symptoms checks. Although more people are getting vaccinated, it will be diligence with these mitigations that will keep COVID-19 infections low and allow sports to continue this spring.
In addition to continued concerns regarding COVID-19 infection, there is growing concern among the sports medicine community of an epidemic of sports injuries this upcoming year. Following the spring 2020 lockdowns, last summer saw a dramatic increase in shoulder and elbow injuries in throwers and other overhead athletes, as well as stress fractures and shin splints in endurance athletes. Fall athletes, including football in states where it was allowed, suffered an increasing number of hamstring, knee and ankle injuries, including anterior cruciate ligament (ACL) injuries. These rises were demonstrated at all levels of competition, including high school, collegiate and professional levels.
Sports medicine experts have been able to identify several key factors to the increased rate of sport injuries. For the past eleven months, athlete’s lives have been inundated with quarantines, closures of gyms and workout facilities, and disruptions and/or cancellations of their sports seasons. Most athletes of today are training year-round for their sport, developing proper loading of their muscles, tendons and bone. The development and maintenance of key physical qualities (e.g. strength, power, high-speed running ability, acceleration, deceleration and change of direction), game-specific contact drills (e.g. tackling) and decision-making ability are challenged during physical distancing and quarantining.
Although many athletes have attempted to stay in shape by working out from home, the lack of coaching guidance may result in suboptimal training and less effective training. Additionally, limitations in in-sport training, in particular for contact sports, leads to a decrease in base endurance, strength and overall fitness that increases the risk of injury. In-sport training allows athletes to build sport-specific fitness and allows the bodies to prepare for sport-specific movements and demands that are really difficult to gain from home exercises or the weight room.
Restarting sports is a marathon, not a sprint. Eager athletes trying to rush back into sports after a prolonged layoff are likely to push too hard and too fast, increasing their risk for injury. It is important for athletes to realize they cannot jump back into their normal level of training, rather they must gradually build up their return to sport. This approach must be customized for each individual athlete and be specific for each sport. The following are some general guidelines for a return to sport:
- “Preseason” (Weeks 1-2)
- Warm up period
- Low to moderate exercises at 20-25% the athlete’s pre-pandemic fitness level
- Focus on flexibility and mobility
- Progressive aerobic, interval and strength training
- Sport-Specific Training (Weeks 3-5)
- Progressive, moderate to high intensity exercises
- Focus on strength and conditioning
- Vary levels of intensity if practicing every day
- On lower intensity days, focus on strategy, execution and skill
- Return to Sports (Weeks 6-8)
- Resume traditional training regimen
Finally, it is important to realize that this upcoming season will not be “normal”. Virtually a full academic year of sports is squeezed into a four month time period. There will be a temptation to “make up for lost time” and try and cram as many games as possible into this compressed season. This strategy will only increase risk of injury, potentially leading to further time for an athlete away from the sport. Additionally, COVID-19 is still among us in the community, and can quickly change any plans or schedules. This season needs to be views as a potential bonus opportunity, a change for young athletes to continue to develop as both athletes and people.