DOES AN ATHLETE NEED TO BE SYMMETRICAL TO RETURN TO THEIR SPORT?

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Tid Bits of Info

  • Usain Bolt is known to have a shorter right leg leading to an impact force of 1,080 lbs on the R and 955 lbs on the L.
  • Most rehabilitation programs attempt to get the injured body part to 90% symmetry of the uninvolved limb.
  • Hamstring strength can be asymmetrical following an autograft ACL reconstruction for 3+ years or more.
  • Following an Achilles tendon rupture / repair, the calf musculature strength might never be 100% symmetrical.
  • Seek the advice and treatment of a Physical Therapist if you suffer an injury and they can help you restore symmetry to your injured body part.

When athletes suffer lower extremity injuries, they cannot return to the sport until their attending healthcare professionals determine it is safe. Traditionally, the healthcare professional would consider the symmetry in an athlete’s body as a key part of assessment to determine a safe return to play date. Symmetry is no longer considered necessary because many athletes did not have symmetry in body parts prior to the injury. The assessment used to determine the return to play time frame should be based on the activity that the athlete is going to play.

Asymmetry is quite common in healthy individuals. When assessing a lower extremity injury, most healthcare professionals will determine the asymmetries that exist and attempt to “link” them to the injury.  Studies currently being completed indicate that the asymmetries might not be the primary cause. In some instances, the asymmetries become more pronounced with fatigue while others are less noticeable in the fatigued state.

For instance, gait asymmetry was present in almost every athlete tested and the ability of these athletes to control their knee motions when they were fatigued lessened significantly.  They could not control their knee motion upon impact with the ground which indicates that they cannot control the eccentric contractions and decelerate their leg motion.  The inability to control their knees with eccentric contractions pre-disposes them to over-use knee injuries.  Some of the asymmetry was “corrected” when the athlete participated in a fatigued state. They become more symmetrical with loading rate upon ground contact when they ran.  This indicates that their body was attempting to dissipate any abnormal “load” that might have been present when they were in a non-fatigued state.

In order to determine the return to play date, the healthcare professional should choose activities or metrics that will simulate what athlete are going to have to do when they play their sports.  Testing someone’s ability to run or jump for a sport that does not require that skill might not be in the best interest of the athlete.  The professional must “break down” the sport into component skills and then assess the athlete’s ability to perform those skills. Based on those results should give the athlete and healthcare provider a clear picture of the true status of the injured athlete.

Anterior Cruciate Ligament (ACL) injuries are very common in today’s sports. The repair and rehabilitation of these athletes is a science that has evolved over the past 25 years to a point where many of the athletes return to their sport in better condition than they were in prior to their injury.  Unfortunately some of the athletes return to full time participation in their sport following the reconstruction of their ACL without using their involved leg symmetrically with the uninvolved knee.  There might never be complete symmetry for many reasons, therefore the athlete and healthcare professional must understand that other body parts will work “harder” to compensate for the reconstructed knee.  This might pre-dispose these body parts to over-use injuries. Proper rehabilitation workouts must involve the entire body in an attempt to prevent injuries to uninvolved parts of the body.

The body works as one big unit when it is functioning properly.  The results of the studies indicate that the nervous system is able to “adjust” or “compensate” for the asymmetries that exist and make the body perform in a way that reduces the chances of developing an injury.  Obviously this does not always occur and over-use injuries result in pain and loss of participation in a given sport.

Physical Therapists are trained at assessing a patient’s ability to be functional with a particular activity.  If the client is unable to perform a task or has experienced an injury, the Physical Therapist is one of the best healthcare professionals to assess the status and develop a program that will treat and correct the problem that is causing the symptoms.  If there is an asymmetry, the Physical Therapist will determine if it is the cause of the athlete’s condition.

Seeking advice and treatment from a Physical Therapist does not require a doctor’s prescription.  You need to check with your insurance company because your policy might require that you have a referral from your general practitioner which is different from the doctor’s prescription.

Symmetry in body parts would seem to be needed to be perfectly healthy and prepared to return to a sport, but it appears that symmetry might never return to 100%. Asymmetry that develops following an injury is might not be as bad as most healthcare professionals once believed because some of it was probably present prior to the injury.  Compensating for asymmetry is very common and it might be wise for healthcare professionals to assess these asymmetries and try to develop a rehabilitation program around them.