Sports & Orthopaedic Care
From Injury to Peak Performance
Evidence-based approaches for athletes of all levels — from weekend warriors to elite competitors. Complete guide to common injuries, rehabilitation phases, return to sport criteria, and prevention strategies.
"Return to sport isn't just about healing — it's about preparing the athlete to handle the demands of their sport."
Most Common Sports Injuries
Understanding the most frequent injuries helps with prevention and early intervention.
ACL Rehabilitation:
Complete Protocol
ACL tears are season-ending but not career-ending. Proper rehabilitation is essential for safe return to sport.
Non-contact ACL tears often occur with:
- Sudden deceleration + cutting
- Landing with knee extended
- Pivot with foot fixed
- Valgus collapse (knee caves in)
Surgery typically recommended for:
- Young, active individuals
- High-demand sports (pivoting)
- Giving way episodes
Non-surgical possible for:
- Older, less active
- No instability
- Willing to modify activities
ACL Reconstruction Timeline
| Phase | Timeline | Key Goals | Criteria to Progress |
|---|---|---|---|
| Phase 1 | Weeks 0-2 | Full extension, quad activation, swelling control | Extension 0°, quad set with lag <5° |
| Phase 2 | Weeks 2-6 | Full ROM, normal gait, early strengthening | Full extension, flexion 120°, no effusion |
| Phase 3 | Weeks 6-12 | Strength, balance, proprioception | Single leg balance 30s, LSI strength >70% |
| Phase 4 | Months 3-6 | Running, plyometrics, sport-specific | LSI >80%, pain-free running |
| Phase 5 | Months 6-9 | Return to training | LSI >90%, hop tests >90% |
| Phase 6 | Months 9-12+ | Return to competition | All RTS criteria met |
"Time-based protocols are outdated. Return to sport should be CRITERION-BASED. Rushing return before meeting strength and functional tests increases re-injury risk by 7x."
Shoulder Injuries in Sports
The shoulder is vulnerable in throwing, swimming, racquet sports, and weightlifting.
Spectrum from tendinopathy to partial/full tears.
- Symptoms: Pain with overhead activity, night pain, weakness
- Common in: Swimmers, baseball, tennis, volleyball
Treatment: Eccentric strengthening, scapular control, activity modification. Most respond to physiotherapy.
The humeral head moves excessively in the socket.
- Symptoms: Apprehension, giving way, recurrent dislocations
- Common in: Contact sports, gymnasts, young athletes
Treatment: Rotator cuff and periscapular strengthening, proprioception. May require surgery if recurrent.
- Pain control
- Passive range of motion
- Scapular setting
- Avoid aggravating positions
- Active range of motion
- Rotator cuff strengthening
- Scapular control
- Proprioception
- Sport-specific drills
- Plyometrics
- Interval throwing programs
- Gradual return
Common Running Injuries
Running injuries are often overuse-related. Understanding the cause is key to recovery.
Pain around or behind kneecap. Worse with hills, stairs, sitting.
Management: Quad strengthening (especially VMO), glute strengthening, taping, load management.
Lateral knee pain. Common in runners with high mileage.
Management: Glute medius strengthening, hip abductor strength, foam rolling (controversial), gait retraining.
Pain in Achilles tendon. Often from sudden increase in training.
Management: Eccentric heel drops, isometric holds, load management, avoid complete rest.
Bone stress injury. Common in tibia, metatarsals.
Management: Relative rest, identify risk factors (RED-S, biomechanics), gradual return.
- Sudden increase in mileage (>10% per week)
- Previous injury (strongest predictor)
- Low running experience
- High weekly mileage
- Biomechanical factors (individualized)
The 5 Phases of Sports Rehabilitation
Every sports injury follows a predictable rehabilitation progression — from protection to performance.
- Pain and swelling control
- Protect injured structures
- Maintain fitness (cross-train)
- Pain-free range of motion
- Full range of motion
- Isometric strengthening
- Begin loading tissues
- Normalize gait/movement
- Progressive resistance
- Eccentric strengthening
- Balance and proprioception
- Sport-specific movements
- Plyometrics
- Agility drills
- Sport-specific skills
- Gradual training load
- Meet RTS criteria
- Full training participation
- Gradual competition return
- Prevention programme
Return to Sport Criteria
Clearing an athlete to return requires meeting objective criteria — not just time passed.
| Domain | Assessment | Criteria | Target |
|---|---|---|---|
| Pain & Swelling | Self-report, clinical exam | No pain during activity | 0/10 |
| Range of Motion | Goniometer | Full, symmetric ROM | 100% |
| Strength | Handheld dynamometer, isokinetic | Limb Symmetry Index | ≥90% |
| Hop Tests | Single hop, triple hop, crossover | LSI on all tests | ≥90% |
| Movement Quality | Video analysis, tuck jump, LESS | No valgus, good control | Pass |
| Sport-Specific | Position-specific drills | Full intensity, no pain | Pass |
| Psychological | ACL-RSI, I-PRRS | Confidence to return | ≥80% |
Returning before meeting these criteria increases re-injury risk by up to 7x. A second ACL injury can be career-ending. Take the time to do it right.
Essential Exercises for Sports Rehab
These exercises form the foundation of many sports rehabilitation programs.
- Pain during exercise should be ≤3/10 and settle within 24 hours
- Quality over quantity — good form prevents re-injury
- Progress load gradually (10% rule)
- Always work with a sports physiotherapist for proper progression
Injury Prevention Strategies
Up to 50% of sports injuries are preventable with the right approach.
The FIFA 11+ warm-up program reduces injury rates by 30-50% in soccer players. Similar programs exist for other sports.
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