Sporting injuries are common across all levels of physical activity and can range from minor strains to serious trauma. The effective management and prevention of sporting injuries rely on early assessment, tailored rehabilitation and adherence to return-to-play guidelines. A coordinated approach involving athletes, coaches and medical professionals helps minimise time lost to injury and ensures a safe return to peak performance.

Understanding how sports injuries are classified is essential for appropriate treatment and prevention. Injuries are typically grouped based on their cause (direct or indirect), the type of tissue affected (soft or hard) or whether they occur suddenly or develop over time (overuse). These classifications guide assessment, management and rehabilitation protocols in sport settings.

Accurate on-field injury assessment is crucial in determining whether an athlete can continue playing or requires further care. The TOTAPS method; Talk, Observe, Touch, Active Movement, Passive Movement and Skill Test, provides a systematic approach to evaluate the nature and severity of an injury in real-time, ensuring safety and timely intervention.

TOTAPS test - provides a structured on-field assessment process:

• Talk – Ask the athlete what happened, where it hurts and how the injury occurred.

• Observe – Look for visible signs of injury: swelling, deformity, bruising or bleeding.

• Touch – Gently palpate the area to locate pain, swelling or abnormal lumps.

• Active Movement – Ask the athlete to move the injured area independently.

• Passive Movement – Move the injured part through its range of motion without athlete assistance to assess pain or restriction.

• Skill Test – Ask the athlete to perform a sport-specific movement (only if pain-free in earlier stages) to determine readiness to continue or stop play.

Effective injury management in sport begins immediately after the injury occurs and focuses on minimising damage and accelerating recovery. Applying first-aid principles such as RICER and avoiding harmful practices (HARM) in the early stages lays the foundation for safe and efficient healing. Management approaches differ for acute and chronic injuries but aim to restore function while preventing complications.

Acute Injury Management

• Follow the RICER principle in the first 48–72 hours - Rest, Ice, Compression, Elevation, Referral to medical care.

• Avoid HARM (Heat, Alcohol, Running, Massage) immediately after injury.

Chronic Injury Management

Involves rest, physiotherapy, gradual return to activity and addressing underlying biomechanical or training errors.

 Rehabilitation is the structured process of restoring physical function after an injury. It includes progressive mobilisation, graduated exercise, training and therapeutic use of heat and cold. The goal is to safely rebuild strength, flexibility and confidence, allowing athletes to return to their sport with reduced risk of reinjury.

Progressive mobilisation is the gradual reintroduction of movement to the injured area, aiming to restore joint mobility and flexibility without causing further damage. It begins once the acute inflammatory stage has passed, typically 48–72 hours after injury. Involves gentle, pain-free range-of-motion exercises (e.g. ankle circles, passive knee bends) to prevent joint stiffness and maintain functional mobility. It also encourages synovial fluid circulation, reducing the risk of scar tissue formation and promoting healing. For example, a netball player recovering from a sprained ankle may begin mobilisation by performing controlled ankle dorsiflexion and plantarflexion movements while seated.

Graduated exercise involves a step-by-step progression in physical activity to rebuild strength, coordination, balance and endurance in the recovering limb or body part. It is tailored to the type and severity of injury and begins with isometric exercises (e.g. muscle contraction without movement) before progressing to isotonic movements and resistance-based training. It incorporates proprioceptive activities (e.g. balance board work) and functional drills as the athlete’s capacity improves. For example, a footballer recovering from a hamstring strain may start with bridges and hamstring curls before progressing to agility drills and sprinting over time.

As physical capacity returns, training focuses on regaining sport-specific skills and conditioning through carefully planned activities that replicate competition demands. It is introduced after adequate strength and flexibility are restored and includes technical drills, tactical routines and game-like scenarios to rebuild performance confidence. Training intensity and load are increased progressively while monitoring for signs of fatigue or re-injury. For example, a swimmer recovering from shoulder tendinopathy may progress from basic pool mobility drills to full-stroke technique sets and race-pace intervals.

Cold Therapy (Cryotherapy) is used to minimise inflammation, reduce blood flow and manage pain in the acute phase of injury. Methods include ice packs, ice baths or cold compression devices. It is most effective within the first 48–72 hours post-injury or after training sessions during early rehabilitation stages. For example, an athlete with a soft tissue thigh contusion may apply ice for 20 minutes every 2 hours during the initial 48-hour period.

Heat Therapy (Thermotherapy) is used to increase blood circulation, relax muscles and alleviate stiffness during later recovery stages. Methods include heat packs, warm baths and infrared heat. Heat is applied before mobility exercises or rehabilitation sessions to improve flexibility and readiness. For example, a basketball player in the later stage of ACL rehabilitation might use a heat pack before functional training to ease joint stiffness.

Return-to-play (RTP) refers to the structured and medically-informed process that guides an athlete’s safe return to training and competition after injury. It is essential that RTP decisions consider not only the physical healing of the injury but also the athlete’s functional ability, psychological readiness and the demands of their specific sport. 

The key elements of RTP include:

• Medical Clearance provided by a qualified health professional (e.g. physiotherapist, sports physician). This confirms healing through clinical assessment, imaging and functional tests. It may include pain-free range of motion, strength testing and stability assessments.

• Functional Testing evaluates whether the athlete can perform sport-specific movements (e.g. jumping, pivoting, sprinting) at full intensity without pain or limitation. It often involves agility drills, reaction tests and endurance tasks to assess performance under pressure.

• Graduated Return involves progression through stages to allow for ongoing assessment and adjustment of training loads based on athlete response.

• Sport-Specific Criteria differ by sport due to unique physical demands and injury risks. For example, a rugby league player returning from concussion must complete a graduated concussion protocol, while a sprinter returning from a hamstring strain must demonstrate explosive acceleration capability.

• Psychological Readiness - an athlete must feel confident, motivated and mentally prepared to return. They may be assessed through interviews or questionnaires such as the Injury-Psychological Readiness to Return to Sport Scale.

Responsibilities:

• Medical team: Conduct assessments, oversee rehabilitation and provide formal clearance.

• Coaches and trainers: Modify training sessions to meet the athlete’s current capability and monitor readiness during re-integration.

• Athlete: Must communicate honestly about symptoms and confidence levels and comply with rehab and training programs.

• Parents/Guardians (for junior athletes): Ensure their child’s best interests and long-term health are prioritised.