Return to Play Post COVID
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Millions of young athletes participate in some form of athletics worldwide. The COVID pandemic ultimately shut down many sports over the course of nearly two years living with the virus. During that time, postponement of these events raised concerns in the medical community due to athletes’ long periods of inactivity, which ultimately increases the risk of injury. However, as sporting events and athletes get back on the courts, a growing concern is now mounting for those athletes that have had a positive covid test. To reduce the risk of injury when these athletes return to play, guidance is needed on return to play for the safety and health of these athletes.
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Throughout the COVID pandemic, children, adolescents and young adults have lacked the opportunities to be physically active. Besides the lack of available sports, most of these children have been learning on a virtual platform, which also increases sedentary time. Obesity rates have increased throughout all children, with ages 5 through 9 being most affected (Centers for Disease Control and Prevention, 2021).
When children return to play, they should be encouraged to start at a low intensity and go slow. A graduated return to play guide has been published to provide recommendations to those athletes who have tested positive for COVID. It recommends the following:
| • | Athletes must be able to complete activities of daily living and walk without excessive fatigue or breathlessness |
| • | Have at least five days of rest with no exercise |
| • | Isolation periods have been followed per local public health department |
| • | Symptoms have resolved or significantly improved, including no fever (less than 100.4) for 24 hours without the aid of fever reducing medication |
| • | Individual was not hospitalized due to COVID infection (Henry Ford Allegiance Health, 2021) |
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One of the biggest concerns following a COVID diagnosis are cardiac complications like myocarditis. Myocarditis is an inflammation of the muscle surrounding the heart. A recent study of 26 competitive athletes post COVID infection showed per cardiac MRI, that 15 percent of those individuals had myocarditis (Ahmad, 2021).
Cardiac clearance on the graduated return to play checklist consists of the following questions:
| • | Chest pain/tightness with exercise |
| • | Unexplained syncope/near syncope |
| • | Unexplained/excessive dyspnea/fatigue with exertion |
| • | New palpitations |
| • | New heart murmur on physical exam |
If any of the cardiac screening questions are positive or if an athlete was hospitalized during their COVID infection, further workup is indicated (HFAH, 2021). A referral to cardiology is recommended for further assessment and clearance. Further assessment may include blood testing, cardiac monitoring including: echocardiogram or EKG and respiratory function testing.
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As the pandemic continues to evolve and change, so may the return to play format. However, following consistent guidance on return to play for athletes can reduce the risk of injury. By doing so, we are keeping the best interest of the athlete at the forefront of care.
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