Progressing On-Court Rehabilitation After Injury: The Control-Chaos Continuum Adapted to Basketball

Key Points

1. The return to play process is a balance of progressive constraints within sport that coincide with the requisite physical attributes needed to execute those activities.
2. This commentary highlights many performance variables that are often overlooked within the rehab process.
3. The continuum showcases a progressive return to sport participation that outlines not only what to do, but when and how to do it within a well-defined periodization model.

BACKGROUND & OBJECTIVE

Return to sport following injury is a complex process and should be viewed on a continuum, aligning an athlete’s recovery and rehabilitation. This clinical commentary discusses the dynamic and complex process of returning an athlete from injury to full participation in the sport of basketball. The article highlights the many moving parts that are integrated within sport and effectively demonstrates how to manage all requisite parts within the complex systems and chaos of basketball.

The objective of the article is to provide an all-encompassing process that considers all key stakeholders involved in the return to play process.

Return to sport following injury is a complex process and should be viewed on a continuum, aligning an athlete’s recovery and rehabilitation.

The Control-Chaos Continuum model creates a framework to help guide any profession through the return to play process.

METHODS

The authors created a working model titled the Control-Chaos Continuum. The Continuum highlights a progressive model of High Control, Low Chaos to Low Control, High Chaos. Control is defined as the volume of constraints and limitations as defined by the medical & performance team. These constraints are often based on the type, severity, and location of the injury in addition to the biological timeline of the injury.

Chaos is defined by the volume of uncontrollable factors that exist in sport. Chaos is the opposite to control. As the volume of control decreases, the volume of chaos increases. The commentators have created a simple yet comprehensive diagram to highlight this continuum.

RESULTS

The commentators provide a comprehensive battery of tests to help guide the decision-making process of the return to play. The process includes several objective measures that help guide the inclusion of sport participation dependent on the outcome of the prescribed test. The testing battery is intended to assess a specific physical quality that is a requisite to be able to participate in the next level of intensity and movements within sport.

LIMITATIONS

Return to sport is not entirely black and white. Not all injuries have well-defined specific protocols that are consistent across teams and/or sports (1). The return to sport decision is a balance of science, art, and business. Injury prediction models, machine learning, artificial intelligence, and sports science models help support objective decision making yet ultimately none of them are perfect. This commentary provides a comprehensive model and management tool, yet similar to other return to play models it lacks a specific, criteria for each phase.

CLINICAL IMPLICATIONS

The findings of this commentary help the sport physical therapist better understand the dynamic integration of medicine, rehabilitation, performance, and sport. Sports teams’ medical and performance staffs continue to grow and integrate many disciplines, yet often struggle with process-oriented decision-making. Emotions run high in the sporting environment and business implications can add an additional layer of complexity.

This article helps the practitioner better understand the comprehensive processes that are needed to work alongside varying professions to achieve high performance (2). Similar to rehab and strength training, the sport itself can be periodized if we manipulate volume, intensity, number of players, and field size. The use of Local Positioning Systems (LPS) such as Kinexon or Global Positioning Systems (GPS) such as Catapult, have helped educate the world of sports that the various practice drill types or small sided games expose the athletes to varying volume and intensities of physical demands (3).

Successful return to play in the present-day era of high performance requires a dynamic, integrated process across multiple departments. The Control-Chaos Continuum model creates a framework to help guide any profession through the return to play process. The Model educates us on how to better understand the demands of sport and how we can gradually re-integrate athletes into play while simultaneously progressing the physical qualities needed to be successful within each phase.

+STUDY REFERENCE

Taberna M. Spencer N. Murphy B. Antflick J. Cohen DD. Progressing On-Court Rehabilitation After Injury: The Control-Chaos Continuum Adapted to Basketball. J Orthop Sports Phys Ther. 2023;53(9):498-509.

SUPPORTING REFERENCE

1. Wilkstrom, E. A., et al. (2019). Lack of Consensus on Return-to-Sport Criteria Following Lateral Ankle Sprain: A Systematic Review of Expert Opinions. Journal of Sport Rehabilitation, 2020, 29, 231-237
2. DeWeese, B. H., Hamilton, D. K., Huls, S., Peterson, B. J., Rath, T., & Althoff, A. Clarifying High Performance and the Role, Responsibilities, and Requisite Attributes of the High-Performance Director in American Professional Sport. Strength and Conditioning Journal. 2023;45(4):429-438.
3. Klusemann, M. J., Pyne, D. B., Foster, C., & Drinkwater, E. J. Optimising technical skills and physical loading in small-sided basketball games. Journal of Sports Sciences. 2012;30(14):1463-1471. doi: 10.1080/02640414.2012.712714.