Rehabilitation of athletes: from injury to full load

A consensus statement from 2016 is based on a meeting of 17 experienced clinicians at the World Congress in Sports Physical Therapy in Bern [1]. The statement describes return to sport as a continuum, and distinguishes between three steps: return to participation, return to sport and return to performance [1].

This means that an athlete can take part in adapted training long before full competition load is relevant. Rehabilitation and return go hand in hand.

The statement describes the decision as a risk assessment made jointly by the athlete, clinician, coach and any others involved [1]. The athlete is an active participant in the decision, and roles should be clarified early [1].

Those involved may have different tolerance for risk. A process for handling disagreement is therefore recommended, so that the athlete is not put under pressure [1]. They may also define success differently, for example quick return, performance or prevention of new injury. This should be agreed in advance [1].

The statement proposes looking at the condition of the tissue, the loads the tissue is to tolerate, and how much risk the athlete and those around them tolerate [1]. A biopsychosocial approach can help the clinician understand individual factors that affect the return [1].

Fear of reinjury, self-efficacy and motivation influence the return, and psychological readiness should be assessed both during rehabilitation and in the transition back to sport [1]. Load management can be used to plan progression, but the use of the ratio between acute and chronic load in rehabilitation needs more research [1].

Tests should not only include closed tasks such as hop tests. They should also have reactive elements, since sport demands decisions under fatigue [1].

The statement gives some examples. For Achilles tendinopathy it mentions that the athlete has completed a programme of progressively increasing load, and that pain during activity is no higher than 5 out of 10 and has settled by the next day [1]. For hamstring injuries there are no validated objective criteria. Common approaches are pain-free testing, symmetry in strength and range of motion, and sport-specific tests [1].

The authors stress that the evidence for many return criteria is weak or lacking [1]. The examples are taken from an international statement and do not necessarily apply to the individual athlete.

Some acute injuries, such as concussion, require the athlete to be removed from sport immediately [1]. In other cases the decision may be to reduce the load, or to stop entirely for a period [1].

A physiotherapist with specialisation in sports physiotherapy can examine the injury, go through your training load and make a rehabilitation plan in dialogue with you and, where relevant, your coach. You do not need a referral from a doctor to book an appointment [3]. You can read more about running injuries, diagnostic ultrasound and shockwave therapy.

What does return to sport mean?

Return to sport is a process with three steps: return to participation, return to sport and return to performance. It runs in parallel with rehabilitation [1].

How long does rehabilitation after a sports injury take?

There is no single timeline for all injuries. The statement describes that the criteria for return vary between injuries, and that the evidence for many of them is weak [1].

Who decides when I can play again?

The decision is made jointly by the athlete, clinician, coach and any others involved, and the athlete takes an active part [1].

Does it matter if I am afraid of getting injured again?

Fear of reinjury, self-efficacy and motivation influence the return to sport. The authors recommend assessing psychological readiness during rehabilitation [1].

What is a sports physiotherapist?

Sports physiotherapy is one of the master's programmes and specialisations within physiotherapy [2].

You can read more about running injuries and about physiotherapy. You can find more articles in the overview of articles.

This article was written by Dr.Dropin Fysikalske and is based on the sources listed below. It gives general information and does not replace an examination by a healthcare professional.

The websites were accessed and read on 22 October 2026.

1. Ardern CL, Glasgow P, Schneiders A, Witvrouw E, Clarsen B, Cools A, et al. 2016 Consensus statement on return to sport from the First World Congress in Sports Physical Therapy, Bern. Br J Sports Med. 2016;50(14):853-864. doi:10.1136/bjsports-2016-096278. Link

2. Fysioterapeut (Physiotherapist). Utdanning.no. Reviewed in cooperation with the Norwegian Physiotherapy Association 22 May 2025. Link

3. Fysioterapeut Marius Knudsen (Physiotherapist Marius Knudsen). Dr.Dropin Fysikalske. Link