Return to Performance Protocols and Criteria Specific to Aerobic Capacity for Aerobic Athletes Who Sustain Lower Extremity Injuries: A Narrative Review

Abstract

Return to performance (RTP) protocols vary greatly between sports due to energy system involvement, physical and biomechanical skills, injury type and severity, and varied recommendations from members of the interprofessional care team. Return decisions are guided by clinical reasoning, expert opinion, experience, and sport-specific frameworks. Lower extremity injuries that prevent athletes from continuous aerobic training lead to decreased aerobic capacity upon return, which is linked to increased risk of injury or reinjury. This narrative review compares documented rehabilitation programs and RTP protocols and criteria specific to aerobic capacity for athletes who sustain lower extremity injuries in highly aerobic sports. Databases were searched from 2010 to 2022, yielding 9 primary articles and 11 review articles. No RTP protocol specific to aerobic capacity was identified. Considering the lack of evidence regarding aerobic capacity testing and prescription in RTP protocols, research is necessary to determine the significance of aerobic capacity recommended for RTP. Strength and conditioning coaches should be aware of the decreased aerobic capacity at the time of return, thus the need for additional testing, and implement individualized aerobic conditioning programs to optimize return. .