Return to sport protocol

The Hanbury Return to Sport Protocol, Milton Keynes

Feeling better is not the same as being ready. Most people are told they have "recovered" once the pain has gone and they can move normally again. But that is only the first part of the journey. The real question is whether your body can cope with the sudden stops, changes of direction, and repeated impact of your actual sport, without breaking down again. The Hanbury Return to Sport Protocol exists to answer that question properly, using measurement and, if you have needed it, surgical oversight built in from day one.

Why pain-free doesn't mean ready

Pain is your body's alarm system, and once it switches off, it is natural to assume the job is done. But pain going away tells you very little about whether your strength, control, and confidence have actually returned to a level that can withstand sport. Someone can walk, jog, and go about daily life with no pain at all while still producing 20 to 30% less force through the injured leg than the healthy one, something you would never feel day to day, but which shows up clearly under the kind of sudden loading a match or a training session demands. That gap, between "doesn't hurt" and "can take the impact," is exactly where reinjuries happen.

What is the Hanbury Return to Sport Protocol?

It is a five-stage pathway that takes you from your first physiotherapy assessment at Hanbury Health after injury or surgery through to being cleared to return to full training and competition. At each stage, before you are allowed to progress to more demanding activity, you are tested. If the numbers are not where they need to be, you do not move on yet, you keep building until they are. This is what is known in the research as a criteria-based return to sport approach, and it is associated with meaningfully lower reinjury rates than simply returning after a fixed number of weeks (Grindem et al, 2016).

What actually gets measured?

Strength and symmetry. Using force plate and objective strength testing, we measure how much force each leg produces during jumping and landing tasks, and compare your injured side directly against your uninjured side. This produces what is called a limb symmetry index, essentially a percentage score showing how close the injured leg is to matching the healthy one. Research generally uses a threshold of around 90% symmetry as one marker of readiness (Grindem et al, 2016; Kyritsis et al, 2016).

Movement quality. Strength numbers alone do not show how well you control your body under pressure. We also use 3D movement analysis to watch how you land, decelerate, and change direction, picking up on things like your knee caving inward on landing, which a strength test can miss entirely but which raises injury risk on its own.

Psychological readiness. Confidence matters more than people expect. Athletes who do not feel psychologically ready to return, even if their body has met every physical marker, have a measurably higher risk of a second injury (McPherson et al, 2019). We check in on this directly, alongside your body.

Is the evidence on testing settled?

Mostly, but not entirely, and we think it is more honest to say so. Some of the strongest studies show a clear benefit: one showed that following simple, criteria-based decision rules cut the risk of reinjury after ACL reconstruction by 84% (Grindem et al, 2016), and another found that people who did not meet a set of clinical discharge criteria before returning to sport had around four times the risk of graft rupture compared with those who did (Kyritsis et al, 2016). A separate meta-analysis looking specifically at whether passing return-to-sport testing reduces second ACL injury found the evidence more mixed, with no statistically significant reduction shown across the pooled studies (Losciale et al, 2019). What this tells us is that no single test is a guarantee, which is exactly why the protocol combines strength, movement, and psychological measures together together with clinical and, where relevant, surgical judgement, so no single number decides on its own. Our guide to knowing when you are ready to return to sport after ACL reconstruction walks through how those criteria are applied stage by stage.

How does the custom rehabilitation gym fit in?

Testing shows you where you stand; the rehabilitation gym is where the gap actually gets closed. It is built specifically for this kind of progressive, test-gated training, moving from early strength work through to plyometrics, change of direction, and sport-specific drills, all supervised directly by your physiotherapist and built around your own testing data. If your goal sits further along the performance side, the Performance Blueprint testing programme picks up where return to sport testing finishes.

What are the five stages?

1. 01

   Baseline

   A full assessment: strength testing, movement analysis, and, if surgery was involved, direct input from your consultant. This is the starting point everything else gets measured against.

2. 02

   Foundation

   Restoring pain-free movement, range of motion, and basic control. You move on once you hit specific movement milestones.

3. 03

   Build

   Progressive strength and early jumping and landing work in the rehabilitation gym, with clear strength and movement benchmarks gating each step up.

4. 04

   Sport-specific reconditioning

   Change of direction, acceleration, deceleration, and drills that mimic your actual sport, checked regularly against your baseline.

5. 05

   Return to sport testing and graduated return

   The full testing battery, strength symmetry, movement quality, and psychological readiness, followed by a gradual, monitored return to training and then competition.

Why is surgical oversight part of this, even if I haven't had surgery?

If your injury does need surgery, you stay on the same pathway and are not left to find your own way back into rehab. You have direct access to a consultant orthopaedic surgeon as part of the same pathway, so the person who operated on you is involved in the decisions about when and how you return to sport, instead of sending a discharge letter after the fact. Even if surgery is not needed, that same level of oversight is available if anything about your recovery needs a second opinion.

How do I book onto the protocol in Milton Keynes?

It starts with a physiotherapy assessment, booked through Cliniko. From there, your clinician builds your testing and training plan around your specific injury, sport, and goals. It begins with a single assessment, with no upfront commitment to the whole pathway.

Why Hanbury Health is different

Most return to sport advice is still built around a generic timeline: back to running at six weeks, back to full training at three months, regardless of what your body has actually shown it can do. What is different here starts with who is behind it: a founding team with a combined 40 years working in professional sport, applying the same standard to your recovery that is used with professional athletes. If surgery is part of your story, you have direct access to the consultant who performed it throughout your rehab, on the same pathway from the outset. And because testing, hands-on rehab, movement coaching, and surgical input all sit under one roof, a concerning result from a test changes your very next session straight away. The goal is closing the real gap: the one between recovering from an injury and being genuinely ready, physically and mentally, to perform at full fitness without a heightened risk of breaking down again.

Frequently asked questions

How long does the protocol take?

It depends on your injury and where you start, since progression is based on your test results. A straightforward soft-tissue injury might move through in a matter of weeks; a post-surgical ACL reconstruction typically takes several months to reach the final testing stage.

Do I need to have had surgery to use this protocol?

No. The same testing-led structure applies to non-surgical soft-tissue and joint injuries, adjusted to the specific demands of your injury and sport.

What counts as passing the return to sport testing?

A combination of measures: typically a limb symmetry index of around 90% or higher on strength and jump testing, alongside acceptable movement quality and psychological readiness. Your clinician sets the exact thresholds based on your injury and sport, and, where relevant, in discussion with your consultant.

Is this only for elite or professional athletes?

No. The team's professional sport experience shapes the standard, but the protocol is built for anyone returning to the sport or activity they love, from weekend five-a-side to professional competition.

Do I need a referral to start?

No, you can book a physiotherapy assessment directly.

What if I don't hit every threshold?

That's common; it's information that shows where to keep building. You'd continue working on the areas that are behind, with a clear plan for closing the gap, and the decision is based on the whole picture.

References

• Ardern CL, Glasgow P, Schneiders 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;50:853-864.
• Grindem H, Snyder-Mackler L, Moksnes H, Engebretsen L, Risberg MA. Simple decision rules can reduce reinjury risk by 84% after ACL reconstruction: the Delaware-Oslo ACL cohort study. Br J Sports Med. 2016;50:804-808.
• Kyritsis P, Bahr R, Landreau P, Miladi R, Witvrouw E. Likelihood of ACL graft rupture: not meeting six clinical discharge criteria before return to sport is associated with a four times greater risk of rupture. Br J Sports Med. 2016;50:946-951.
• Losciale JM, Zdeb RM, Ledbetter L, Reiman MP, Sell TC. The association between passing return-to-sport criteria and second anterior cruciate ligament injury risk: a systematic review with meta-analysis. J Orthop Sports Phys Ther. 2019;49(2):43-54.
• McPherson AL, Feller JA, Hewett TE, Webster KE. Psychological readiness to return to sport is associated with second anterior cruciate ligament injuries. Am J Sports Med. 2019;47(4):857-862.
• NHS. Sports injuries: recovery and returning to activity. nhs.uk.

This page describes a general framework; your specific testing thresholds and phase progression will be set by your treating clinician based on your injury, surgery (if any), and sport.