British Journal of Sports Medicine | 2019
Progressing rehabilitation after injury: consider the ‘control-chaos continuum’
Abstract
Early reintegration to training and match\xa0play following injury increases the\xa0risk of reinjury. However, having key players available benefits the team.1 Practitioners must balance these two components of the return to sport (RTS) process, combining evidence and clinical experience to estimate this risk, then plan and adapt RTS accordingly.1 Quantifying and monitoring training load is key in guiding this process while managing reinjury risk,2–4 and global positioning systems (GPS) provide a valid measure of external running loads.5 However, as practitioners, we should focus on both\xa0quantitative aspects of running load progression and qualitative characteristics of movement in competition. This includes highly variable, spontaneous and unanticipated movements (the conditions of ‘chaos’) reflecting the unpredictable nature of the\xa0sport.\n\nIn this editorial, we present the ‘control-chaos continuum’ (CCC) (figure 1), interlinking GPS variables, while\xa0progressively incorporating greater perceptual and reactive neurocognitive challenges.6 7 This framework moves from high\xa0control to high\xa0chaos, and is based on more than a decade of rehabilitation and RTS in the demanding setting of English Premier League football.\n\n\n\nFigure 1 \nReturn to sport framework - the control-chaos continuum. Control=high\u2009level of structure on behaviour/actions/movement, that\xa0is, controlled situation. Chaos=unpredictable\xa0behaviour/actions/movement, as to appear random/reactive, that is, chaotic situation. Green represents high control (low intensity) moving towards high chaos (high intensity). Model can be adjusted according to specific injury diagnosis, estimated tissue healing times and expected return to training. Acc/Dec\xa0Magnitude =rate of change in velocity, for\xa0example, 3\xa0ms−2.**Game\xa0load\u2009adjustable dependent on injury type/severity. ACC, accelerations; BW, bodyweight; COD, change of direction; DEC, decelerations; Exp-D, explosive distance (accelerating/decelerating from 2 to 4\xa0ms−1\xa0 5.5\xa0ms−1); MS, maximal\xa0speed; MAXHR, maximal heart rate; PR, passive\xa0recovery; SPR, sprint distance (>7\xa0ms−1); TD, total distance.\n\n\n\nUsing retrospective player\xa0chronic running loads (GPS) in …