Return to Sport
You should not return to sport on a feeling. You should return on evidence.
Criteria-based return-to-sport assessment for athletes in late-stage rehabilitation or cleared elsewhere. Not a calendar. Not a pain threshold. Documented clinical criteria — met or not met.
The assessment
What return-to-sport testing covers.
Bilateral comparison of strength, power, and load tolerance. Asymmetry above accepted thresholds is one of the strongest predictors of reinjury. Clearance requires symmetry criteria to be met — not approximated.
Sport-specific single-leg strength criteria — absolute values and relative to bodyweight — assessed under controlled conditions. Strength at rest does not predict strength under competition load.
Single and double-leg jump tests. Landing mechanics assessed for valgus collapse, trunk control, and asymmetric loading — the patterns that put the repaired tissue at risk on return.
Acceleration, deceleration, and lateral movement capacity — assessed relative to the demands of the athlete's specific sport. Relevant to field sports, racket sports, and court sports.
Tasks drawn from the athlete's actual sport — at near-competition intensity where safe. The tissue is tested in the context it will be used, not in a clinical vacuum.
Confidence under sport-level intensity is assessed alongside physical criteria. Athletes cleared physically but not psychologically have markedly higher reinjury rates. Both must be satisfied.
Why it matters
Why "pain-free" is not clearance.
The most common return-to-sport criterion in standard practice is pain resolution. The athlete reports feeling okay. The clinician sees no significant restriction. The calendar has passed the expected recovery window. Clearance is given.
This is how reinjury happens. Pain-free does not mean load-ready. A tissue can be pain-free at rest and at daily life intensity while still being significantly deficient at the load a sport demands. The ACL that feels stable during a walk is not the same as the ACL under a cutting movement at full sprint.
Criteria-based clearance changes this. It requires the athlete to demonstrate — not report — that the tissue can handle sport-level load. Strength benchmarks met. Symmetry within accepted range. Movement quality maintained under fatigue. Sport tasks performed at near-competition intensity without compensation or avoidance.
Athletes cleared by criteria have significantly lower reinjury rates than athletes cleared by feel. That difference is what this assessment exists to deliver. Read the full breakdown: How Return-To-Sport Testing Works →
The standard
Four questions that must be answered.
Can the tissue accept the load the sport demands?
Not daily life load. Not physiotherapy load. The load of actual competition — accelerations, decelerations, contacts, jumps, throws. If the tissue cannot demonstrate this capacity in assessment, it cannot be expected to tolerate it on the field.
Is bilateral strength symmetry within acceptable range?
The injured side must recover to within a defined percentage of the uninjured side before clearance criteria are met. This threshold varies by sport and by tissue. Below it, the risk of reinjury is elevated regardless of how the athlete feels.
Is movement quality maintained under fatigue?
Most sports injuries happen late in sessions or matches — when the athlete is tired and movement quality degrades. Testing under fresh conditions only misses this risk. The assessment includes tasks performed under simulated fatigue to assess movement quality when it matters most.
Does the athlete trust the tissue under competition intensity?
Psychological readiness and physical readiness are not the same thing — but both matter. An athlete who avoids a cutting movement because they don't trust their knee is at risk even if the tissue is physically ready. This is assessed directly, not assumed from the physical findings.
Who books this assessment
Five reasons athletes come in.
In the final phase of a rehabilitation program — at PhysioPro or elsewhere — and ready to test whether the criteria for return are met.
Returned to sport after an earlier injury, reinjured within months, and now wanting to understand what was missed before going back again.
Back in training but uncertain whether the tissue is genuinely ready or whether the athlete is managing risk without knowing it. The assessment answers this directly.
Returning to competitive sport after an extended off-season or injury layoff and wanting a baseline assessment before ramping training load.
The last gate before return to competition following ACL reconstruction, rotator cuff repair, or other significant surgical procedures.
Case example
What criteria-based clearance changes.
A 22-year-old football midfielder presented seven months after ACL reconstruction. Had completed a twelve-session post-surgical rehabilitation program at a different clinic and been cleared to return to training. Returned to full team training. Reinjured the same knee in a non-contact cutting movement six weeks later.
Presented to PhysioPro post-second injury. Clearance documentation from first rehabilitation reviewed: criteria used were "full range of motion, pain-free, completed rehabilitation program." No limb symmetry testing documented. No single-leg strength benchmarks recorded. No sport-specific functional tasks performed before clearance.
Second rehabilitation at PhysioPro: 18 sessions over eight months. Clearance based on: quadriceps limb symmetry index above 90%, single-leg hop test symmetry above 90%, cutting and deceleration tasks performed at full speed with no avoidance behavior. Return to competitive play at month nine. No further knee injury reported at twelve-month follow-up in this case.
Case presented with patient consent. Identifying details modified.
Questions
Common questions about return-to-sport assessment.
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How long does a return-to-sport assessment take?
A full session — approximately 60 minutes. It includes strength testing, limb symmetry evaluation, functional movement assessment, and sport-specific tasks. You leave with a documented clearance decision or a specific list of deficits to address before return.
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Can I book this without having rehabbed at PhysioPro?
Yes. You do not need to have completed rehabilitation here. If you rehabbed elsewhere and want an independent clearance evaluation — or if you were cleared and reinjured — that is exactly what this assessment is for.
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I am already training but want to know if I am truly ready. Can I book this?
Yes. Many athletes return to training before their tissue is fully ready — because "feeling okay" is an imprecise clearance criterion. The assessment establishes whether your current training load is within your tissue's actual capacity, or whether you are managing risk without knowing it.
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How does psychological readiness factor in?
Psychological readiness — confidence in the tissue under sport-level intensity — is assessed alongside physical criteria. Athletes who are physically cleared but not psychologically ready have significantly higher reinjury rates. The assessment includes sport-specific tasks at near-competition intensity to assess both dimensions.
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What happens if I do not meet the criteria?
You leave with a specific list of the criteria not yet met and a clear program to address them. The assessment is not a pass-fail gate — it is a clinical map. It tells you exactly what the tissue still needs and provides a structured path to get there.
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How many sessions does full rehabilitation take before I can return to sport?
This depends entirely on the injury, severity, and what was done before this point. A late-stage athlete already deep in rehabilitation may need only 4–6 more sessions to reach clearance criteria. Someone who rehabbed incompletely elsewhere and reinjured may need 12–18 sessions of structured loading before the tissue meets the criteria required. After the first session, you will have a specific and honest estimate — not a fixed number, but a clear picture of where you are relative to where you need to be.
More questions? See the full FAQ →
Every return-to-sport assessment is conducted by Leonardo Machado directly. No assistants, no handoffs. The same clinician who assesses you interprets the findings, explains the criteria, and builds the program if further rehabilitation is required.
Clearance decisions are based on measured data — strength values, limb symmetry indices, functional test results — not on a feeling or a best estimate. If the number is met, clearance is given. If it is not met, the exact gap and the path to closing it are documented.
Book an assessment
Return to sport on evidence, not assumption.
Return-to-sport assessment · $750 MXN · Zona Rio, Tijuana.