Return From Injury / Rehab-to-Performance Continuum

Return is a continuum that runs alongside rehab, not a single "cleared" moment at the end of it (Ardern et al., 2016). In general terms:

1. Protect — follow your clinician's guidance, settle pain and swelling, keep the rest of the body training.
2. Restore — range of motion first, then basic strength and control at low loads.
3. Build capacity — progressive loading of the injured area, one change at a time.
4. Reintroduce speed and impact — running, jumping, change of direction, as the tissue tolerates them.
5. Return to performance — full, unpredictable, fatigued and sport-specific work.

Each step is a decision about what you can do now, not a date. This page is general information — a specific injury (for example an ACL reconstruction, a rotator-cuff repair or a fracture) needs a diagnosis and a protocol from your clinician, and theirs wins over anything here.

• Load — how much stress a session puts on a tissue: weight, volume, speed, impact.
• Irritability — how easily the area flares up, and how long it takes to settle.
• Limb symmetry index (LSI) — the injured side's result as a percentage of the other side's, on a strength or hop test.
• Pain monitoring — rating pain during and after activity (0–10) and using how it responds over the next day to adjust the next session.
• Clearance — a clinician's decision about what you may do. A coach reviewing your programming is not a clearance.

Progress is judged on several things together — symptoms, movement, strength, confidence — rather than on time alone (Ardern et al., 2016).

Pain monitoring, with its limits. In one randomised trial in people with Achilles tendinopathy, patients kept training using a pain-monitoring model: pain during activity was allowed up to about 5 on a 0–10 scale, as long as it settled by the next morning and didn't build from week to week (Silbernagel et al., 2007). That is one condition, one protocol — it is not a pain limit for every injury. Your clinician may set a different rule, or none.

Strength symmetry, with its limits. In athletes returning to pivoting sports after ACL reconstruction, those who passed return-to-sport tests — including quadriceps strength and hop tests above 90% of the other leg — had far fewer re-injuries over two years than those who didn't (Grindem et al., 2016). It's a criterion from that population; it doesn't mean "90%" is the bar for every injury or every sport.

Signs to pause and get it checked: new or spreading numbness or tingling, the joint giving way or locking, new swelling, sharp pain that is getting worse, or signs of infection after surgery.

• Talk it through with the clinician who treats you and your coach — what you're allowed to do now, and what would tell you you're ready for the next step.
• Record what your clinician said (who, what it covers, when, when to review it). In Fysiqal that is what lifts an exclusion from your plan; your coach sees it but can't lift it for you.
• Review your plan with your coach. A proposed change shows you before and after, and nothing changes until you accept it.

• A continuum of stages, decided by readiness, not calendar time (Ardern et al., 2016).
• Pain-monitoring rules are condition-specific: up to ~5/10 settling by morning was used in Achilles tendinopathy (Silbernagel et al., 2007) — not a universal limit.
• ">90% symmetry" comes from ACL-reconstruction return to pivoting sport (Grindem et al., 2016) — not a universal bar.
• Keep the rest of the body training; change one thing at a time.
• Your clinician's individual plan always takes precedence.