Return to sport programme

Clearance to return is based on measured strength symmetry, hop test performance and movement quality under load — not on weeks elapsed since surgery or injury. Two athletes at the same time point are frequently at very different stages of readiness.

We test rather than estimate, and we give you the numbers. If you want to return before meeting the criteria, that is your decision and we document it rather than endorse it.

Restore range and reduce swelling. Re-establish muscle activation, which after knee surgery does not simply return with use. Progressive strengthening. Plyometrics and landing mechanics. Change of direction. Sport-specific work at increasing intensity. Then graded return to training before return to competition.

Skipping the landing and change-of-direction phases is the most common reason for re-injury, because those are the movements in which injuries actually occur.

After ACL reconstruction, returning before nine months and returning without meeting strength and hop criteria are each independently associated with substantially higher re-injury rates 1. Meeting the criteria matters as much as the time.

We will give you the figures for your situation rather than an opinion, because this is a decision an athlete should make with numbers in front of them.

A substantial proportion of athletes who are physically ready do not return, and fear of re-injury is the most common reason. It is measurable with validated scales and it responds to graded exposure.

Ignoring it produces athletes who pass every physical test and never play again, which is a failed rehabilitation whatever the strength numbers say.

The date on which tissue has healed is not the date on which an athlete is ready. Strength symmetry, hop performance, landing mechanics and change-of-direction control all lag behind healing, and returning before they recover is what produces second injuries.

The programme therefore discharges against criteria rather than against elapsed months, and it states what those criteria are at the start so the athlete knows what they are working towards.

After anterior cruciate ligament reconstruction the risk of a further injury — to either knee — is substantially elevated in the first year of return, and it falls with each month of delay and each criterion met.

That trade-off belongs to the athlete, not to us, but it has to be presented with numbers rather than as encouragement. Coaches and clubs push for earlier return; a criteria-based report gives the athlete something to push back with.