The Return to Sport Agenda: A Phased Approach to Safe and Effective Recovery

Returning to sport (RTS) after injury is about restoring capacity, building resilience, and minimising re-injury risk. Whether you are recovering from a sprained ankle or reconstructive surgery, a well-structured return-to-sport (RTS) plan is essential for long-term success.

The RTS agenda consists of four key phases

1. Acute Phase

2. Loading Phase

3. Strength & Plyometric Phase

4. Return to Sport Phase

   
   

Each phase has distinct goals, progression criteria, and evidence-based interventions, helping ensure a safe and confident return to performance.

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1. Acute Phase: Control, Protect, Prepare

• Timeline: 0 - 7 days (varies depending on injury severity)

• Focus: Minimise damage, protect tissues, manage pain and inflammation

• Goals:

  1) Reduce swelling and pain

  2) Maintain joint mobility and circulation

  3) Protect the injury (bracing, taping, or less weight-bearing)

  4) Begin early gentle activation where appropriate

  
  

• Evidence-based interventions:

  1) RICE principles (Rest, Ice, Compression, Elevation)

  2) Gentle active range of motion (within tolerance)

  3) Isometric exercises for muscle activation

  4) Education on load management and expectations

  
  

Significance: The acute phase sets the tone for a successful recovery by ensuring the injury stabilises and the body is ready for progressive rehabilitation.

2. Loading Phase: Restore Mobility and Movement Patterns

• Timeline: 1 - 4 weeks post-injury (depending on tissue type and healing rate)

• Focus: Controlled loading, reintroducing movement, rebuilding capacity

• Goals:

  1) Restore normal range of motion

  2) Begin load-bearing activities (e.g. walking, basic squatting, stepping)

  3) Develop foundational neuromuscular control

  4) Introduce low-level balance and coordination exercises

  
  

• Evidence-based interventions:

  1) Closed kinetic chain exercises (e.g. bodyweight squats, calf raises)

  2) Gait retraining

  3) Early proprioception drills

  4) Aquatic therapy (if suitable)

  
  

Signifcance: According to current sports medicine guidelines, gradual mechanical loading supports tissue remodelling and prevents muscle atrophy. At this stage, movement quality is more important than intensity.

3. Strength & Plyometric Phase: Build Power, Control, and Resilience

• Timeline: 3 - 10 weeks or longer, depending on the injury

• Focus: Strength, power, and neuromuscular readiness for high-impact sport

• Goals:

  1) Restore strength to pre-injury (or better) levels

  2) Develop explosive power, speed, and reactivity

  3) Improve dynamic balance and movement control

  4) Prepare tissues for high-load, sport-specific tasks

  
  

• Evidence-based interventions:

  1) Progressive resistance training (single-leg, eccentric loading, tempo work)

  2) Plyometric exercises (jumping, hopping, bounding)

  3) Agility drills and change-of-direction tasks

  4) Force plate or strength testing to guide return-to-play benchmarks

  
  

Significance: A 2020 consensus statement from the International Journal of Sports Physical Therapy emphasised that objective strength testing is critical in RTS decision-making. Plyometrics help bridge the gap between static strength and dynamic sport movement.

4. Return to Sport Phase: Functional Readiness and Sport Reintroduction

• Timeline: Based on sport, injury, and individual progress

• Focus: Restore confidence, readiness, and performance under pressure

• Goals:

  1) Resume training with progressive intensity

  2) Reintegrate sport-specific drills and skills

  3) Achieve performance benchmarks and psychological readiness

  4) Prevent re-injury through education and ongoing conditioning

  
  

• Evidence-based interventions:

  1) Sport-specific movement patterns and decision-making tasks

  2) Fatigue-based drills (to mimic game conditions

  3) Psychological screening tools (e.g., ACL-RSI, Tampa Scale)

  4) Return-to-play testing (e.g., hop tests, Y-balance, isokinetic strength)

  
  

Significance: The Australian Sports Commission’s Return to Play model stresses that return to training ≠ return to competition. Athletes must demonstrate functional and psychological readiness, not just absence of pain.

Returning to sport is a process, not a date. By following a structured, evidence-informed agenda through the acute, loading, strength + plyometric, and RTS phases, physiotherapists can optimise recovery, enhance performance, and reduce the risk of re-injury.

Every phase has a purpose, and every athlete deserves a rehab plan that prepares them not just to play again, but to thrive again.

Book with Urban Physiotherapy today to start your Return!

https://urban-physiotherapy.au2.cliniko.com/bookings?business_id=423637795941128200#service