Rehabilitation and Return to Play
Core concepts
Understand phased rehabilitation: control inflammation/pain, restore range of motion, strengthen, then sport-specific function. Know return-to-play (RTP) criteria: pain-free full motion, adequate strength (often ≥90% of contralateral), functional testing, and sport-specific drills. Understand concussion RTP: graduated stepwise return (symptom-limited) with no same-day return. Know ACL reconstruction RTP is typically 9-12 months with strength and functional criteria, not just time. Recognize the value of neuromuscular training in injury prevention.
Traps
A common trap is returning an athlete based on time alone rather than functional criteria. Another is allowing same-day return after concussion-graduated progression is required. Do not skip the psychological readiness component; fear of reinjury affects RTP. Know that early mobilization is generally favored over prolonged immobilization for many injuries.
Rule of thumb
RTP requires the "three S's": Symptom-free, Strength (near symmetric), and Sport-specific function. For concussion, follow the graduated return-to-sport protocol only after return-to-learn is complete.
Worked example
A soccer player 6 months after ACL reconstruction has full motion and no pain but quadriceps strength is 70% of the contralateral side. Do not clear for full play; continue strengthening and functional testing until strength and hop-test symmetry meet criteria, typically closer to 9-12 months.