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Sports Medicine

Transparency in the Return to Game Process

returntogame

A guest post by Anton Blessing, Performance Director at ALLOUT Performance

ALLOUT Performance is an international performance consulting agency, which focusses on the optimal integration of sports coaching, sports science, nutrition, therapy, and medicine. They have worked with Telekom Baskets Bonn professional basketball and icehockey teams like the German National Team, the Kölner Haie, Grizzlies Wolfsburg and Klagenfurt AC.

Anton Blessing instructing Wolfsburg’s right wing Daniel Widing

„Return to Game“ is currently a hot topic in sports medicine. It has always been a hot topic in sports, but I think what has changed is that the discussion is becoming more transparent and our profession is getting better at striking a balance between team performance and individual health. First of all, we as ALLOUT Performance do not have a fixed strategy and force that upon teams. That doesn’t work. We clear our minds and come to each team with an empty piece of paper. What we end up doing depends on the culture, the philosophy, the infrastructure, and the people in this organization. 

It is usually always a tug-of-war between the medical director whose main goal it is to keep the individual players healthy, and the sports coach, who wants to get the player back on the ice to win more games. In my role as performance director I have to set the boundaries for common ground. 


For us at ALLOUT Performance the key components of RTG are :

  • systematized decision making
  • Transparency of communication
  • Minimizing the risk of re-injury
  • Minimizing the time away from the game

For us Systematized Decision Making and Transparency of Communication are the foundation. Without that we will not be effective at minimising the risk of re-injury or minimising the time away from the game. Therefore I will focus in this article on how we approach the foundation.

It is a tug-of-war between the medical director who wants the individual players healthy, and the sports coach, who wants to win more games. As performance director I have to define common ground. Click To Tweet

Systematized Decisionmaking

Usually we are surrounded by really good coaches, doctors, surgeons and physical therapists. The first priority for us is to leverage the competence of each and thereby make the value of the team greater than the sum of its parts. 

We want to find common ground on some fundamental questions :

  • When push comes to shove, how much are we willing to risk individual safety for team performance?
  • Do we aim for QUICK Return to Game, or are we aiming for SAFE Return to Game?
  • What could happen to make us break these promises?

We rather discuss these questions BEFORE the season with everybody, than run into problems when an injury happens or after the season when it comes to evaluating our Return to Game efficiency. It always makes for an interesting discussion. We usually reach the same conclusion every year, but we always learn something and grow as a team. 

From there we break it down in more detail for each type of injury :

  • How do we handle muscle/bone injuries from sideline to hospital and back?
  • How do we handle skin injuries from sideline to hospital and back?
  • How do we handle concussion injuries from sideline to hospital and back?
  • How do we handle illness/sickness from sideline to hospital and back?

From these discussions already a ton of preventative measures are emerging, but also we establish common ground on whats important to take care off when bringing a player back from an injury like this. We as a staff do not want to make „easy“ decisions twice. We set the rules of our decision making and write them down. Then we follow protocol. We want to save our time and energy on the difficult decisions. The decisions where the protocol ends, where we have no protocol. This makes for very efficient and engaging teamwork.

 

 

Transparency of Communication

We all want to speak the same language. Therefore we defined 7 different STAGES of where a player can be at :

Competition – Player is training and competing at full function

Practice – Player is training, but is not competing, because of loss of function (he wears a different coloured jersey so teammates and coaches know to take care)

Sport – Player is training, but in a controlled environment under close watch of the Performance Coach (mostly in the gym, on the track and on the ice)

Training – Player is training, but in a very controlled environment under close watch of the Physical Therapist (mostly in a gym. You could call this Rehab)

Life – Player is at home regenerating (mostly after operations or during sickness)

Hospital – Player is at the hospital

Questionable – Player cannot train and/or compete, but we do not know why -> No Diagnosis yet

We have a huge whiteboard in every facility where we keep these stages of each player up to date. Every morning the Performance Coach and the rest of the Coaching Staff (including Physical Therapists) discuss changes on this board. It is discussed what the next steps will be and where stage changes are expected within the next few days.

We see a lot of teams using technology to do something similar, but we value the time sitting in one room, having coffee and discussing these things in person. All technological solutions we tried led to worse communication. For us in-person communication is of the highest priority.

So when we have these 7 stages it becomes clear that we need to have a strategy to go from stage to stage with the highest efficiency. 

  • How do we transition a player from „HOSPITAL“ to „LIFE“? Is everything arranged to accomodate his injury at home? Does the wife have everything she needs? Do we have to address „boredom“ if it is a player living alone?
  • How do we transition a player from „LIFE“ to „TRAINING“? Whats important at that stage? This is a crucial time to increase nutritional support. 
  • How do we transition from „SPORT“ to „PRACTICE“? Has the player developed all the skills and qualities that are necessary to go back to full skating and light contact?

When we look at the transition from and to each stage from many different angles (emotionally, socially, mentally, physically) we will find central aspects of the „Return to …“ part. 

RETURN TO LIFE

RETURN TO TRAINING

RETURN TO SPORT

RETURN TO PRACTICE

RETURN TO COMPETITION

They all have different emotional, social, mental, and physical needs. To manage the basic transitions from stage to stage within our staff with full transparency we developed a Return to Game Card.

We value the time sitting in one room, having coffee and discussing performance in person. All technological solutions we tried led to worse communication. In-person communication has highest priority. Click To Tweet

 

  CHECK OUT “EISHOCKEY PERFORMANCE” BY ALLOUT PERFORMANCE  

The Return to Game Card

Every player who gets injured receives a „Return to Game“ card.  On this card we combine several things. 

First of all, all medical information is noted on that card. The exact diagnosis, the medical prognosis, and also all medical contraindications. The doctors notes all the things that should NOT be done by therapists and coaches. All therapies and interventions for that player are noted on that card. Every massage, every rehab session, every training session is noted by the coach/therapists and the player rates how hard that session was and how he felt the day after.

As the player has this card with him at all times, every therapist/coach always has an overview of what has been done and how the player reacted to that. Again, there are many technological solutions to that, but we found the good old physical card to be the one solution that actually works for us. 

The second thing that is integrated is a basic overview of some of the physical criteria to go from stage to stage for Upper Body, Lower Body and Head injuries. These are just the basic goals to reach for each stage. To understand how to reach these goals we have separate manuals.

At the beginning of the season we performed many baseline tests to get an idea of their pre-injury function. This included psychometric tests as a baseline for concussion diagnosis and recovery.

The third thing that is integrated on that card is a checklist from TRAINING to COMPETITION. 

For every check there is a different person who is responsible. To have the player go from HOSPITAL/LIFE to TRAINING, the doctor has to sign the card. To have the player go from TRAINING to SPORT, the physical therapist has to sign off. To have the player go from SPORT to TRAINING, the Performance Coach has to sign off, and to go from TRAINING to COMPETITION the Performance Coach and the Head Coach have to sign off. But the final signature is the most important one. The final „I AM READY“ has to be signed off by the player. When he does that without hesitation, then the card will be returned to us and archived. If he is hesitant to do that, then the „Return to Game“ process is not over.

In our experience it is essential for a functioning Return to Game process to get everybody on the same page. Every organisation needs a slightly different infrastructure for that, but we always want to implement a language everybody on the team understands to prevent „communication energy leaks“.

 

Order the Book “Eishockey Performance” [GERMAN], written by ALLOUT Performance

  CHECK OUT A FREE READING SAMPLE OF “EISHOCKEY PERFORMANCE”   

 

With increased transparency we found that the trust of the players towards the staff and the organisations improves. Without trust there is no team. With transparency and shared decision making we are able to bring players on the ice quicker and safer. This increases our chances of being successful. And thats what its all about. 

With transparency and shared decision making we are able to bring players on the ice quicker and safer. This increases our chances of being successful. And thats what its all about. Click To Tweet

Note by Gerrit : If you work in professional sports and would like to add your thoughts on Return to Game, by writing an article, shoot me a message! Click on “Contact” or write me on Twitter @gkeferstein

Anton Blessing

Anton Blessing is the Performance Director for ALLOUT Performance Training. He is a sports scientist with specialisation in Exercise Science and Coaching from the University of Cologne and currently pursues his Masters Degree in Sport Directorship from the University of Manchester.

Tags : icehockeyreturn to gamereturn to competitionanton blessingallout performanceinjury preventionsports medicine

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