Returning to exercise after injury

Define what “back” means

Returning to a short gym session, completing a full training week and performing at your previous level are different milestones.

The Bern return to sport consensus describes three stages: participation in modified activity, return to the sport itself and return to the desired level of performance. The same distinction can help organise a conversation about recreational exercise, even though it is not a universal rehabilitation protocol.

For example, practising controlled tennis drills is not the same as completing a competitive match. Write down the version of the activity you want to reach. This makes the gap between the current stage and the goal more visible.

Time matters, but it is not the only criterion

Healing and procedure specific restrictions matter. A good test result does not authorise you to ignore advice after surgery or a fracture.

Within those boundaries, progression also needs information about what you can do and how you respond. A date in the calendar cannot show that you can tolerate repeated movements, changes of direction or the total amount of exercise in a normal week.

Ask for both parts of the plan: any minimum time or protection requirements, and the functional milestones that will be used. “Six weeks has passed” and “I have practised the required tasks with an appropriate response” are different pieces of information.

Break the activity into its demands

Take the activity you want to resume and describe what it involves. Consider duration, resistance, speed, repeated effort, changes of direction and how much recovery is available.

For a return to tennis, the questions might include sustained movement, quick stopping, lateral movement, confidence in the ankle and tolerance of a full session. For the gym, they might concern the specific lift, load, range, repetitions and the rest of the week’s training.

This is more useful than asking whether an injury is “100% healed” as a general statement. It helps identify which part of the activity is ready to progress and which still needs work.

What should be assessed beyond pain?

Pain matters, but so do strength, movement, endurance, control and confidence. The useful measures depend on the injury and the intended activity.

For acute lateral ankle sprains, the PAASS consensus framework identifies five areas for return decisions: pain, ankle impairments, the athlete’s perception of readiness, sensorimotor control and sport performance. It was developed through expert consensus, not as a universal passing score.

In plain language, a review might ask whether symptoms are manageable, whether the ankle can perform the required work, whether balance and control are appropriate, whether the person trusts it and whether sport specific tasks have been completed.

No single calf raise count, symmetry percentage or pain score can replace that whole discussion.

A staged example for returning to tennis

The following illustrates how a clinician might organise milestones after an assessed ankle injury. It is not a set of exercises or a timeline to follow independently.

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The progression might pause, move sideways or revisit an earlier task. The decision should use the person’s response and the treating team’s guidance, not pressure to meet a predetermined match date.

The 2021 ankle sprain clinical practice guideline supports structured rehabilitation selected around the injury and individual needs. It does not prescribe one universal return schedule for every ankle sprain, much less every injury.

Change the exercise dose deliberately

An increase can come from more weight, repetitions, time, speed or complexity. Changing several at once makes it harder to identify what was tolerated.

For example, a proposed return session might keep the exercise and load stable while adjusting the number of sets. Another might keep total duration steady while introducing a more demanding movement. The appropriate variable depends on the problem being addressed.

This is a way to make decisions clearer, not a validated rule that only one thing can ever change. It also does not create permission to exceed medical restrictions.

Look at the whole week. Rehabilitation exercises, gym training, classes, work demands and sport all contribute to the activity being attempted. A new session should not be considered in isolation from everything else.

Keep a response record that helps someone make a decision

A brief record is often enough. Use the same categories each time:

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“Completed the planned drills, then noticed swelling later and more difficulty with stairs the next morning” gives the clinician more useful information than “it was a bit sore”.

The record is not a rule that symptoms are acceptable as long as they settle by morning. The response that is acceptable for one condition may be inappropriate for another. Establish your specific action plan with the treating clinician, and seek assessment sooner for concerning changes.

Be careful with symmetry scores

A symmetry result compares one side with the other. It does not establish that either side has enough capacity for the goal.

As a mathematical example, 270 N of force on one side and 300 N on the other gives the same 90% ratio as 135 N and 150 N. The ratio alone cannot tell you the absolute capacity, task quality or whether the task represents the demands of sport.

Use the actual results, symptoms, previous performance where available and relevant task demands. A favourable percentage should not become a shortcut to clearance.

Make the roles in your care clear

Your GP, surgeon, physiotherapist, AEP or coach may each contribute different information. With your consent, the plan should identify current restrictions, exercise priorities, review criteria and who to contact when something changes.

At Longevico, the focus is on exercise assessment, progression and physical capacity within our scope. We do not override procedure specific instructions or replace a medical assessment that is still needed.

A new injury, marked swelling, loss of usual function or rapidly worsening symptoms should prompt reassessment rather than simply reducing the next session. Suspected serious injury requires appropriate urgent care.

Prepare for a useful review

Bring the activity you want to return to, the instructions already provided, a list of your current exercises and a short response record. Ask: “What is the next milestone, how will we assess it, and what would make us change the plan?”

The initial Clinical Exercise Assessment can help clarify the exercise and capacity component when it is appropriate to proceed. Another practitioner may need to assess the injury or update restrictions first.

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