Impact IQ Series: Recovery is a team sport within a team sport.

PAT KARNS MA, ATC, LAT

Impact IQ Series: Inside the Work

Most people imagine one person responsible for getting an NHL player back on the ice.

The reality is an entire ecosystem working in tandem – every single day.

We spoke with Pat Karns MA, ATC, LAT, former Head Athletic Trainer with the Colorado Avalanche, now working in physical rehabilitation at Boone Heart Institute in Greenwood Village, CO, about what recovery and return-to-play actually look like inside an elite hockey organization.

Recovery is a team sport within a team sport.

The public sees the player. They rarely see who's behind him. In an NHL environment, recovery draws on orthopedic physicians, physiatrists, internal medicine doctors, neurologists, neurosurgeons, neuropsychologists, osteopaths, dietitians, athletic trainers, physical therapists, massage therapists, and acupuncturists,  all communicating in real time, all aligned around one athlete's readiness.

"It's a team effort. Recovery isn't just about treating an injury — it's about managing workload, optimizing sleep and nutrition, maintaining neuromuscular function, and ensuring the athlete can handle the demands of a full NHL schedule."

And it's not just injury management. This process runs continuously throughout the season, whether a player is hurt or not.

When the data doesn't match what you see on the ice, that's where the real work begins.

Return-to-play decisions get complicated when objective testing, clinical presentation, and on-ice performance tell different stories. Pat's position on this is unambiguous: if those factors don't align, the player doesn't go back.

But the more important question isn't whether to hold someone back, it's figuring out what's missing and why.

"When there's a disconnect, we shift from decision-making to problem-solving. The goal becomes identifying what piece hasn't come back online – and why."

One example: vestibular-ocular-motor (VOM) therapy, used when tracking, balance, or spatial awareness hasn't fully returned, things that are critical in a fast, reactive sport like hockey, but that standard testing doesn't always catch. The gray area isn't something to push through. It's something to resolve.

Return-to-play is a progression, not a clearance.

The final stage of recovery at the NHL level looks nothing like signing off on a form. Pat describes a carefully sequenced process: video analysis of skating stride, then rigorous skating drills with a skating coach assessing edge work, acceleration, and transitions under fatigue. Then puck handling. Then non-contact drills at game speed. Only then, full-contact practice.

Throughout every step, objective data and on-ice observation are running in parallel. Fluidity, confidence, the absence of compensatory movement, these aren't soft signals. They're essential data points.

"If the data and the real-world performance don't match, the athlete isn't ready. It's that simple."

What's coming next could change everything.

When Pat looks ahead five years, one thing stands out clearly: AI is going to transform how recovery decisions get made at the elite level, not by replacing clinical judgment, but by synthesizing data at a scale no individual practitioner can match.

Movement patterns, neuromuscular control, workload, sleep, HRV, cognitive readiness, all of it processed continuously, surfacing deviations before they become injuries, and providing athletes and practitioners with a clearer, more complete picture than has ever been possible.

"AI will provide athletes with an encompassing amount of information that will enable a safer return to play, and ultimately return them at or above their previous performance level."

Elite recovery isn't a moment, it's a system. One built from dozens of specialists, layered data, and a progression that only ends when every signal points the same direction.

The goal was never just getting a player back on the ice. It was getting them back performing,  and keeping them there.

🔁 Impact IQ Series: Inside the Work — real conversations on how performance and recovery are actually built. Follow Cognitive Protocol for more. #CognitiveProtocol #ImpactIQ #NHLRecovery #ElitePerformance #ReturnToPlay #SportsMedicine #HockeyPerformance #AthleticTraining #HighPerformance #SportsScience