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Return to sport questions & evidence

Graded loading and testing before you go back to full play. What athletes ask us, then what the research shows.

Reviewed by Elias Nghaywe, DPT, MScUpdated 24 October 20266 min read5 studies

Elias Nghaywe seated with a kettlebell in the clinic training area

Your questions, answered

What patients ask us most about return to sport, in plain words.

When can I go back to my sport?

When you pass the tests, not only when the calendar says so. Time matters, especially after knee surgery, but strength, hop and movement tests tell us whether your body is ready for what your sport demands.

What do return-to-sport tests involve?

Comparing strength between your legs, hop tests, running and change-of-direction drills, and questions about how confident you feel. We aim for the injured side to reach about 90% or more of the healthy side before full return.

How long after ACL surgery?

In a large study, each month of waiting up to nine months after surgery cut the reinjury rate by about half. Most people need at least nine months, and they also need to pass their tests.

I feel fine. Why do I need testing?

Feeling fine and being ready are not the same thing. Strength gaps often remain after the pain has gone, and those gaps are linked to reinjury.

What happens between rehab and full games?

A graded return: team training without contact, then full training, then match minutes, increasing step by step while we watch how your body responds.

Can I lower the chance of getting injured again?

Yes. Keep doing a short strength and balance routine even after you are back. Short warm-up programmes and exercises such as the Nordic hamstring curl cut injuries considerably (see below).

What the research shows

Key findings from systematic reviews, randomised trials and major studies indexed on PubMed. Numbers link to the full references below.

Better together: time and strength

Prospective study · 106 patients

After ACL reconstruction, returning to sport at 9 months or later, and with more equal thigh strength between legs, substantially reduced reinjuries. Each month of waiting up to 9 months cut the reinjury rate by 51%.[1]

Pass the tests first

Cohort study · 158 professional athletes

Professional athletes who returned to sport after ACL reconstruction without meeting all six discharge criteria (strength, running and hop tests) had four times the risk of rupturing the new ligament.[2]

Fewer hamstring injuries

Cluster-randomised trial · 942 players

Adding the Nordic hamstring exercise to football training cut acute hamstring injuries by about 70%, and repeat hamstring injuries by about 85%.[3]

Fewer knee injuries

Cluster-randomised trial · 4,564 players

A 15-minute neuromuscular warm-up (core stability, balance and knee control), done twice a week, reduced the rate of ACL injury by 64% in adolescent female football players.[4]

Prevention programmes work

Review of 8 meta-analyses

ACL injury-prevention training programmes halved the risk of ACL injury in athletes, and cut non-contact ACL injuries in female athletes by two thirds.[5]

How we use it at Dr. Phyx

We test before we clear you: strength, hop and movement tests, plus how confident you feel. Then we build a graded return with you and, if you have one, your coach.

Once you are back, we give you a short maintenance programme to keep the risk of reinjury down.

Always by a qualified specialist, after a full assessment, because your health comes first.

When we are careful

Slow down and get reassessed if you notice:

  • Swelling in the joint after training or games
  • The knee or ankle giving way
  • Pain that is worse the next morning and keeps building week after week
  • Fear of a movement that makes you hold back
  • A new injury or a knock to the same area

Ready to get back in the game?

Send us a message on WhatsApp. We will tell you honestly whether it suits your case, and book a first assessment if it does.

Ask on WhatsApp

References

  1. Grindem H, Snyder-Mackler L, Moksnes H, Engebretsen L, Risberg MA. Simple decision rules can reduce reinjury risk by 84% after ACL reconstruction: the Delaware-Oslo ACL cohort study. Br J Sports Med. 2016;50(13):804-808. PubMed · doi:10.1136/bjsports-2016-096031
  2. Kyritsis P, Bahr R, Landreau P, Miladi R, Witvrouw E. Likelihood of ACL graft rupture: not meeting six clinical discharge criteria before return to sport is associated with a four times greater risk of rupture. Br J Sports Med. 2016;50(15):946-951. PubMed · doi:10.1136/bjsports-2015-095908
  3. Petersen J, Thorborg K, Nielsen MB, Budtz-Jørgensen E, Hölmich P. Preventive effect of eccentric training on acute hamstring injuries in men's soccer: a cluster-randomized controlled trial. Am J Sports Med. 2011;39(11):2296-2303. PubMed · doi:10.1177/0363546511419277
  4. Waldén M, Atroshi I, Magnusson H, Wagner P, Hägglund M. Prevention of acute knee injuries in adolescent female football players: cluster randomised controlled trial. BMJ. 2012;344:e3042. PubMed · doi:10.1136/bmj.e3042
  5. Webster KE, Hewett TE. Meta-analysis of meta-analyses of anterior cruciate ligament injury reduction training programs. J Orthop Res. 2018;36(10):2696-2708. PubMed · doi:10.1002/jor.24043

This article is general information reviewed by a physiotherapist. It is not a diagnosis or a personal treatment plan.