Return To Sprint Progression: A Comprehensive Physical Therapy Rehabilitation Protocol

This protocol outlines a structured, progressive rehabilitation program designed to guide athletes back to sprinting activities following an injury. The progression is divided into phases based on pain level, tissue healing, and functional capabilities. The specific timeline and progression through each phase will vary depending on the individual athlete, the nature and severity of the injury, and their response to treatment. This protocol should be used in conjunction with clinical judgment and regular reassessment.

Pathophysiology

Injuries that necessitate a Return to Sprint Progression can range from acute muscle strains (e.g., hamstring, quadriceps, groin) and ligament sprains to more chronic conditions such as tendinopathies (e.g., Achilles, patellar) or stress fractures. These injuries often occur due to overuse, sudden acceleration/deceleration, inadequate warm-up, poor biomechanics, or insufficient recovery. The underlying pathology involves tissue damage and inflammation, leading to pain, reduced range of motion, strength deficits, and impaired proprioception, all of which compromise the athlete's ability to sprint safely and effectively.

Phase I: Protection (Acute Phase)

Goal: Reduce pain and inflammation, protect healing tissues, and restore basic range of motion.

• Timeline: 1-7 days (variable based on injury severity)
• Criteria to Advance:
  • Pain-free at rest or with minimal activity.
  • Significant reduction in swelling and inflammation.
  • Initiation of pain-free range of motion exercises.
• Interventions:
  • Pain Management:
    • Rest, Ice, Compression, Elevation (RICE) protocol.
    • Modalities: Electrical stimulation (e.g., TENS), ultrasound (with caution), cryotherapy.
    • Pain medication as prescribed by a physician.
  • Range of Motion (ROM):
    • Gentle, pain-free active-assisted and passive ROM exercises for the affected joint(s).
    • Examples: Ankle pumps, knee extensions/flexions, hip flexion/extension.
    • Progress to active ROM exercises as tolerated.
  • Muscle Activation:
    • Isometric exercises for surrounding musculature (e.g., quadriceps sets, hamstring sets, gluteal sets).
    • Focus on neuromuscular control and muscle activation without exacerbating pain.
  • Weight Bearing:
    • Protected weight-bearing as tolerated, using crutches or other assistive devices if necessary.
    • Gradual progression to full weight-bearing as pain allows.
• Precautions:
  • Avoid activities that exacerbate pain or swelling.
  • Monitor for signs of increased inflammation.

Phase II: Loading (Sub-Acute Phase)

Goal: Restore full range of motion, improve strength and neuromuscular control, and begin functional loading.

• Timeline: 1-4 weeks (variable based on injury severity and response to treatment)
• Criteria to Advance:
  • Full pain-free ROM.
  • Improved strength (at least 70% compared to the unaffected limb).
  • Ability to perform basic functional movements without pain.
• Interventions:
  • ROM and Flexibility:
    • Continue active and passive ROM exercises, progressing to dynamic stretching.
    • Examples: Heel slides, hamstring stretches, quadriceps stretches, calf stretches.
    • Focus on restoring optimal joint mobility.
  • Strengthening:
    • Progressive resistance exercises targeting affected and surrounding muscles.
    • Examples: Bodyweight squats, lunges, calf raises, hamstring curls, leg press.
    • Introduce resistance bands or light weights as tolerated.
    • Emphasis on proper form and technique.
  • Neuromuscular Control:
    • Balance and proprioception exercises to improve stability and coordination.
    • Examples: Single-leg stance, wobble board, balance pad.
    • Progress to dynamic balance exercises.
  • Low-Impact Aerobic Exercise:
    • Initiate low-impact activities such as cycling or elliptical training to improve cardiovascular fitness.
    • Monitor for pain and adjust intensity accordingly.
• Precautions:
  • Avoid activities that cause pain lasting longer than 24 hours.
  • Gradually increase load and intensity to avoid re-injury.

Phase III: Return to Function (Advanced Rehabilitation)

Goal: Restore sport-specific skills, improve power and speed, and prepare for return to sprinting.

• Timeline: 2-8 weeks (variable based on sport and individual needs)
• Criteria to Advance:
  • Near-full strength (at least 90% compared to the unaffected limb).
  • Pain-free performance of sport-specific movements.
  • Successful completion of agility drills.
• Interventions:
  • Plyometrics:
    • Initiate plyometric exercises to improve power and explosiveness.
    • Examples: Box jumps, hopping, skipping, bounding.
    • Start with low-intensity, high-repetition exercises and gradually increase intensity and decrease repetitions.
  • Agility Drills:
    • Implement agility drills to improve change of direction, speed, and coordination.
    • Examples: Cone drills, shuttle runs, ladder drills.
    • Progress from simple to complex drills.
  • Running Progression:
    • Begin with walking and jogging, gradually increasing speed and distance.
    • Introduce sprinting drills, starting with short distances and gradually increasing length and intensity.
    • Focus on proper running mechanics and technique.
  • Sport-Specific Training:
    • Incorporate sport-specific activities to prepare the athlete for competition.
    • Gradually increase the intensity and duration of training sessions.
• Precautions:
  • Monitor for signs of overtraining or re-injury.
  • Proper warm-up and cool-down are essential.
  • Ensure adequate rest and recovery between training sessions.

Common Special Tests

These tests should be performed throughout the rehabilitation process to assess progress and identify any limitations.

• Hamstring Strain:
  • Straight Leg Raise (SLR)
  • Prone Knee Bend (PKB)
• Quadriceps Strain:
  • Thomas Test
  • Ely's Test
• Groin Strain:
  • resisted hip adduction
  • Palpation of adductor muscles
• Achilles Tendinopathy:
  • Thompson Test
  • Arc Sign
  • Royal London Hospital Test
• Anterior Cruciate Ligament (ACL) Injury (relevant as secondary consideration for stability):
  • Lachman Test
  • Anterior Drawer Test

Disclaimer: This rehabilitation protocol is a general guideline and should be adapted to the individual athlete's specific needs and injury. Consultation with a qualified healthcare professional is essential for proper diagnosis and treatment.