Return to exercise

You can read many blogs where it is explained the path to follow to return to practice your sport after injury (click on here to see an example) and they give you advice in a few paragraphs. I do understand that it is very difficult to do it in another way, as we all look for short easy reads. Nowadays, we are too busy to dedicate long time to read articles. Even though, I wanted to show you how many factors your physio needs to take into account before you return to your normal activity (sport). I hope this post makes you realise how tough the role of physios can be in some situations.

Let’s divide these factors your physio needs to consider before you return to exercise into 3 main groups:

  1. Health status.
  2. Risk.
  3. Change of decision .

Health status

Tissue healing can be predicted, although you need to have quite a lot of information:

  • Age and sex: They will influence the recovery time due to hormonal and age-related factors. For instance, a 60 year-old-man  will need more time to recover from an injury than a 25 year-old-man. Also, women and men will have different recovery times, as the hormones and quantity of them we have are different.
  • Symptoms: They are going to guide us in this process, as if they are present, it would mean that the problem is still there. For instance, stiffness in the morning when you have Achilles tendinitis.
  • Signs: They could be also a guide to be sure if it is time to return to exercise. We could compare strength and range of motion of the person before the injury and at the current moment.
  • Potential seriousness: You need to take into account that every single tissue and type of injury has a different healing time. An ankle sprain will heal earlier than a broken bone.
  • Personal medical history (PMH): It will help to understand the current injury as well as the recovery time needed. For example, you have to distinguish between recurrent and first-time injuries (usually you have to be more careful with recurrent injuries). Also, medical history might predispose to different injuries and it will make us understand a bit better where the injury comes from.
  • Laboratory tests: Scan, ultrasound, MRI (magnetic resonance imaging) and so on, can give us information about the stage of the healing process.
  • Functional tests: There are thousands of functional tests, usually performed by your physio, that can give your useful information about your current state (strength, range of motion,  proprioception, etc.)
  • Psychological state: Fear and anxiety are associated with a higher risk of re-injury as well as negative effects on performance.


  • Sport: Obviously, it is not the same to be a swimmer than a runner or a rower.
  • Position: If we talk about football, for instance, it is not the same to be a goalkeeper as a striker. Hand injuries will affect more goalkeeper performance while leg injuries will be more restricting for strikers.
  • Limb dominance: Let’s imagine that you are a right-handed tennis player and you got a right wrist sprain. It is obvious that it will affect your return to play more than if the injured wrist were the left one.
  • Level: The higher the level of the sport, the more you will push yourself and the higher risk of re-injury.
  • Protection:  For some injuries, a good protection might allow you to get back to your sport sooner than without that protection.

Change of decision

  • Timing: Depending on the moment of the year you are in (for example, off-season), it might not be necessary to return to your sport quickly and this will mean that you can take it easy and the risk of re-injury will be lower.
  • Own and external pressure: The patient might put pressure on the therapist because he wants to get back to his/her sport straight away. Also, the patient might have the pressure from his team, as he might be getting money without playing and the team needs him, as he might be an important piece of the team. Sponsors, fans, coach and so on, can be a source of pressure as well.
  • Masking the injury: You can increase the risk of re-injury by taking medicines that will mask your pain and/or inflammation. This is very risky, as you will not realise you are worsening your state.
  • Conflict of interest: I have lived this and I didn’t like it. This happens when you work for a team and they put pressure on you to make player play as soon as possible and you know that the player shouldn’t play. The team might not be happy with you at all and your position in the team might become a bit uncomfortable. For me the player health is more important than the bank account of the team (health has nothing to do with business).
  • Fear of litigation: Sadly, nowadays, people sue other people easily and this makes physios be sometimes more careful than needed, which could make the patient return to his/her sport later than it should be.

Note that you can find all the information about this topic in this paper.

Comments are always welcome, as you are an important piece in the success of this blog.

If you have any questions, do not hesitate to contact me on The Physical TherapyPhysiotherapy Clinic based in Southampton, and I will be happy to help you.

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