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By Michele Firra Ward, PT. An injury has occurred while participating in a favorite sport or athletic activity and is serious enough to come out of the game, but what do you do next? And, when can the athlete young or old get back into the game?

Typical initial treatment of a sports injury follows the first aid principles to reduce inflammation and pain. The acronym "RICE" represents the steps to be taken: rest, ice, compression and elevation. The severity and area of injury may also require a trip to see the doctor, surgery, taping, bracing and physical therapy.

Restoring movement and strength should be included in the next phase of treatment and should be started as soon as directed by the doctor or physical therapist. At this point pain should still guide how much and how fast activities can be restored. When strength and flexibility return to normal levels a gradual return to sports drills and practice can be phased in, working at about half of normal practice for a few weeks. During this "re-entry" phase of healing, drills for balance, stability, agility and speed should be included. The general guideline for safe return to play is: pain-free with activity, no swelling, full movement and full or near complete (90%) restoration of strength.

Lower extremity injuries, specifically knee and ankle injuries are most common in sports requiring cutting and jumping. The athlete is safe to return to practice when he or she is able to perform full weight bearing on the injured hip, knee or ankle without difficulty.

The decision to return to sports after a neck injury can be difficult as there are a wide variety of opinions in management of the injury. The onus is on the physician to consider the risks involved for the patient who wants to return to the same sport. The literature is in agreement, however. The basic guidelines for return to collision sports are: normal strength, pain-free movement, stable vertebral column and sufficient space for the spinal cord and spinal nerves to avoid spinal cord or spinal nerve compression.

Sports-related head injuries are surprisingly common and too often not treated seriously enough. The majority of head injuries in young athletes are mild traumatic brain injuries or concussions. Any athlete that shows signs of a concussion should not be allowed to return to play. Signs of mild brain trauma include immediate and brief loss of consciousness, brief amnesia, fatigue, headache, disorientation, nausea, vomiting, "feeling out of it" or "in a fog" and forgetfulness.

The athlete should be completely asymptomatic when he or she returns to his or her sport. Parents, teachers and coaches must observe the injured young athlete very closely through the recovery process. The high school athlete who is eager to return to competition and eager to capture collegiate scholarships  or go to advanced competitive levels may press his or her parents and coaches to return him or her to play too soon therefore, risking even more serious and permanent injury. Sports and athletic competition after all, should be about promoting health and physical and psychological well-being.