Greater Risk Of Injury For Athletes Returning From COVID-19 Coronavirus Training Restrictions

As sports begin to be played at all levels, athletes are excited to return to play. Many have been training on their own during the coronavirus lockdowns. But factors other than training and conditioning may lead to a much greater risk of injury during the return-to-play phase.

Across the US and Europe, sports are making a return. Athletes are emerging from lockdowns and stay-at-home orders, ready to compete at all levels. Many have been grinding away in solitude, staying ready to play. But their training time away from peers, teammates and competitors isn’t enough to make them ready to play, says a new study.

Researchers from the University of Bath are blowing the whistle on athletes regarding their readiness for play. They say that the prolonged period of individual training players have dealt with leaves them unprepared for the physical and mental rigors of competition.

In particular, those in contact sports are particularly at risk. Football, rugby, hockey and lacrosse come to mind. However, physical play is common in other sports as well, including basketball and soccer. The research was published in the International Journal of Sports Medicine.

Professor Keith Stokes writes that individual physical training alone can’t replicate the intensity, variability and unpredictability of live competition or even practice. That puts every athlete at greater risk of injury during the return-to-play phase. The paper includes recommendations for resuming training.

Part of the risk stems from the need to train for evasive maneuvers, tracking and mirroring other players and body contact. It is very difficult to mimic game situations when training alone. The researchers also suggest that the restrictions on practice and games resulting from the response to the COVID-19 virus impacts player morale, leading to negative effects on their mental health.

A practical example of what they are espousing can be seen in the experience of the American National Football League in 2011. Disagreements over player pay and other financial issues led to a 20-week lockout. When competition resumed, injury rates rose. Notably, a significant number of Achilles heel injuries were noted.

Professor Keith Stokes from the University of Bath’s Department for Health and also England Rugby explains: “After months out of the game, without access to proper training facilities for much of that time, the return to playing matches must be carefully managed.

“Clubs must balance the need to prepare players for high levels of performance, the risk of injury after such a long lay-off, and the risk of infection with SARS-CoV-2. The key will be to build appropriate progression into training to give players the safest and most effective possible return.”


Some of the practical advice the team offers for protecting athletes from injury during the resumption of sports include:

  • A complete sports medical examination prior to returning to full sports practice and training. This should be used to design appropriate training progressions.
  • Athletes should use the restricted training period to assess and work on their individual weaknesses. For example, if an athlete has a history of knee injuries, strengthening the glutes, quads and other muscles involved in knee stabilization is advised.
  • Create individualized return-to-training and -play plans for each athlete.
  • Athletes who have had COVID-19 will need particular attention. There may be negative impacts on strength and muscle mass. Additionally, the infection may have had affects on the heart.

Physical abilities aren’t the only thing that may have suffered during COVID-19 restriction periods. Nutrition status and mental health may have suffered, too. These cannot be ignored when planning training, practice and return-to-play schemes. The authors recommend using a high-protein diet and supplementing with vitamins C and D, as well as probiotics where needed.

Also a concern is “detraining syndrome.” This often occurs for competitive athletes when their normal sports, training and practice activities are abruptly ended. It’s not unusual for these athletes to suffer from anxiety, depression and insomnia. These can all directly impact their physical fitness, which can delay their ability to successfully begin practicing and training again.

While the authors suggest that most players will bounce back during a preparation period of about six weeks, not all will. The variables and issues they outline should be carefully considered when creating training and practice plans. A lot depends on how long the athlete has been away from competition and practice and even on the conditions under which practice and games can resume.

I’ve written and spoken previously about the reality that highly competitive athletes, at all levels, are “at-risk.” They thrive on routine as well as challenge. When either is taken away, it can impact them in unpredictable ways. When both are abruptly removed, the results can be devastating, especially to mental health.

Return-to-play plans need to take all these factors into account. If done thoughtfully, athletes will be able to safely and successfully return the to sports they love healthy, whole and ready to go.

Keep the faith and keep after it!

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Journal Reference – Keith A. Stokes et al, Returning to Play after Prolonged Training Restrictions in Professional Collision Sports, International Journal of Sports Medicine (2020). DOI: 10.1055/a-1180-3692

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