Physical TheraPT
Clinical Wisdom
Shannon Vigil
Superbill Best Practices
The Recovery Mindset
Nina Szemis, ATC
Can You Outrun Illness?

General common sense, as well as scientific research, tells us that lifelong physical activity acts as a protecting agent against chronic illness and disease. If you’re able to consistently rack up 300 minutes of moderate intensity activity per week, you’re at much lower risk for things like cancer, cardiovascular disease and other inflammatory disorders. Regular physical activity also increases your resilience against communicable diseases, like bacteria and viral infections. However, here’s where the research starts to diverge.

Athletic Performance

Are You Spring Ready?

Spring sports ramp up fast — practices lengthen, intensity spikes, and competition schedules fill up. Whether you’re a high school athlete or a weekend warrior, your performance and durability are built long before the first game. In this blog, you’ll find tips for maximizing spring sport performance and the checklist every high school athlete and weekend warrior needs, covering strength, mobility, progressive speed exposure, and recovery strategies to set the stage for a healthy, successful season.

When the weather shifts, so does activity. Spring sports ramp up fast — practices get longer, intensity spikes, and competition schedules stack up quickly.

But here’s the truth:

Injuries don’t spike because spring arrived. They spike because preparation didn’t happen in winter.

Across both high school athletes and adult recreational athletes, research consistently shows the same pattern: early-season overload, overuse accumulation, and inadequate strength or tissue preparation drive injury rates up.

Let’s break it down.

 

High School Athletes: The Early-Season Risk Is Real

 

Track & Field

  • Overall injury rate: 0.84 injuries per 1,000 athlete exposures

  • Girls experience 37% higher injury rates than boys

  • Nearly 70% of track athletes sustain at least one injury in season-long studies

  • Training in spikes + ≥6 hours every two weeks increases injury risk 8-fold

Lower extremity injuries dominate — especially hamstrings, calves, knees, and ankles.

Translation: Winter should focus on posterior chain strength, tendon loading, and progressive speed exposure — not just mileage.

Baseball & Softball

  • Shoulder and elbow injuries are most common

  • Pitchers account for nearly 40% of shoulder injuries and 57% of elbow injuries

  • Injury rates are highest in the first month of the season

Translation: Arm care, scapular strength, and gradual throwing volume must begin in winter — not at the first bullpen.

Tennis (Youth)

  • Lower extremity injuries (knee & ankle) are most common

  • 43% of injuries cause >4 weeks missed

  • Training ≥3x/week or >4.5 hours/week doubles injury risk

Repetitive rotation + quick direction changes stress both lower body and shoulder complex.

Translation: Winter needs rotational strength, landing mechanics, and ankle stability work.

Weekend Warriors: The Spring Surge Problem

Adults face the same issue — compressed preparation and intensity spikes.

Recreational Runners (5K/10K Season)

  • Most common: shin splints, Achilles tendinopathy, patellofemoral pain

  • Median recovery time: 56 days

  • Poor sleep, high mileage (>20km/week), and higher bodyweight increase risk

Protective factor?
Foot-core strength training reduces injury risk by 60%.

Translation: Winter is the time to build tissue tolerance gradually — not jump into race mileage.

Adult Recreational Soccer

  • 60% sustain at least one time-loss injury per season

  • Knee (29.9%) and ankle (12.4%) most injured

  • 30% of injuries last >1 month

  • 14% are reinjuries

Contact accounts for over half of injuries — but many ligament injuries stem from poor neuromuscular control.

Translation: Winter should include deceleration drills, landing mechanics, and strength for joint stability.

Pickleball (Especially 50+)

  • 34% of recreational players report injury annually

  • Knee, elbow, shoulder most common

  • Achilles ruptures often require surgery

  • Fracture risk increases after age 60

Interestingly, experience and consistent play reduce injury risk — so if you’re gonna play, maybe don’t make it your annual “dust off the cleats and hope for the best” appearance.

Join a regular group. Your muscles (and your pride) will thank you.

Translation: Winter should emphasize balance, calf strength, and reactive footwork.

Why Winter Matters

The first month of spring season consistently shows the highest injury rates across multiple sports.

That tells us one thing:

The body wasn’t prepared for the demand.

Winter training should:

  • Build tendon resilience

  • Increase force production capacity

  • Improve neuromuscular control

  • Gradually expose athletes to speed and volume

Preparation reduces the “too much, too soon” spike.

Winter-to-Spring Readiness Checklist

High School Athlete Checklist

Strength

☐ 2–3x/week lower body strength (posterior chain focus)

☐ Single-leg strength work

☐ Core anti-rotation & rotational strength

☐ Arm care program (for overhead athletes)

Mobility

☐ Ankle dorsiflexion mobility

☐ Hip internal rotation

☐ Thoracic rotation

Speed & Conditioning

☐ Gradual sprint exposure (no sudden spikes)

☐ Acceleration + deceleration drills

☐ Progressive volume build

Recovery

☐ 8+ hours sleep

☐ At least 1 rest day/week

☐ Monitor soreness and early pain signals

 

Weekend Warrior Checklist

Strength

☐ 2x/week resistance training

☐ Calf and Achilles loading

☐ Knee control exercises

☐ Foot-core training (especially runners)

Volume Management

☐ Increase mileage or play time ≤10% per week

☐ Avoid jumping from “zero to league play”

Balance & Stability

☐ Single-leg balance drills

☐ Lateral movement prep

☐ Deceleration mechanics

Lifestyle Factors

☐ Prioritize sleep

☐ Manage stress

☐ Address lingering injuries before season start

Final Takeaway

Spring performance is built in winter.

Whether you're a high school sprinter, a pitcher, a tennis athlete — or a 42-year-old signing up for a 10K — the research says the same thing:

Preparation determines durability.

Train smart now.
Load gradually.
Build tissue capacity before demand spikes.

Because the goal isn’t just starting the season.

It’s finishing it healthy. 

References:

  1. Epidemiology of Injuries in United States High School Track and Field: 2008-2009 Through 2013-2014. Pierpoint LA, Williams CM, Fields SK, Comstock RD. The American Journal of Sports Medicine. 2016;44(6):1463-8. doi:10.1177/0363546516629950.

  2. Prevalence, Incidence and Characteristics of Musculoskeletal Injuries in Athletics (Track and Field): A Systematic Review and Meta-Analysis. Edouard P, Tsukahara Y, Mann RH, et al. British Journal of Sports Medicine. 2026;:bjsports-2025-110541. doi:10.1136/bjsports-2025-110541.

  3. Epidemiology of Overuse Injuries in US Secondary School Athletics From 2014-2015 to 2018-2019 Using the National Athletic Treatment, Injury and Outcomes Network Surveillance Program. Post EG, Simon JE, Robison H, Morris SN, Bell DR. Journal of Athletic Training. 2022;57(5):510-516. doi:10.4085/1062-6050-600-20.

  4. Training in Spikes and Number of Training Hours Correlate to Injury Incidence in Youth Athletics (Track and Field): A Prospective 52-Week Study. Ek A, Kowalski J, Jacobsson J. Journal of Science and Medicine in Sport. 2022;25(2):122-128. doi:10.1016/j.jsams.2021.09.006. 

  5. Shoulder Injuries in US High School Baseball and Softball Athletes, 2005-2008. Krajnik S, Fogarty KJ, Yard EE, Comstock RD. Pediatrics. 2010;125(3):497-501. doi:10.1542/peds.2009-0961. 

  6. Epidemiological Features of High School Baseball Injuries in the United States, 2005-2007. Collins CL, Comstock RD. Pediatrics. 2008;121(6):1181-7. doi:10.1542/peds.2007-2572. 

  7. Epidemiology of Shoulder and Elbow Injuries Among United States High School Baseball Players: School Years 2005-2006 Through 2014-2015. Saper MG, Pierpoint LA, Liu W, et al. The American Journal of Sports Medicine. 2018;46(1):37-43. doi:10.1177/0363546517734172. 

  8. Incidence of Injuries in High School Softball and Baseball Players. Shanley E, Rauh MJ, Michener LA, Ellenbecker TS. Journal of Athletic Training. 2011 Nov-Dec;46(6):648-54. doi:10.4085/1062-6050-46.6.648.

  9. Epidemiological Analysis of Pediatric Baseball and Softball Concussions in United States Emergency Departments. Abed V, Hawk GS, Conley C, Akarakian R, Stone AV. The American Journal of Emergency Medicine. 2023;69:143-146. doi:10.1016/j.ajem.2023.04.025. 

  10. Injury Profile in Junior Tennis Players: A Prospective Two Year Study. Hjelm N, Werner S, Renstrom P. Knee Surgery, Sports Traumatology, Arthroscopy : Official Journal of the ESSKA. 2010;18(6):845-50. doi:10.1007/s00167-010-1094-4. 

  11. Racket Sports-Related Injuries in Youth Athletes: A Narrative Review. Shrestha M, Usmani A, Karlov S, Harris A, Patel DR. International Journal of Environmental Research and Public Health. 2026;23(1):135. doi:10.3390/ijerph23010135. 

  12. Epidemiology of Musculoskeletal Injuries in Tennis Players: Risk Factors. Minghelli B, Cadete J. The Journal of Sports Medicine and Physical Fitness. 2019;59(12):2045-2052. doi:10.23736/S0022-4707.19.09842-6. 

  13. Diagnoses and Time to Recovery Among Injured Recreational Runners in the RUN CLEVER Trial. Mulvad B, Nielsen RO, Lind M, Ramskov D. PloS One. 2018;13(10):e0204742. doi:10.1371/journal.pone.0204742. 

  14. Factors Associated With Lower Limb Injuries in Recreational Runners: A Cross-Sectional Survey Including Mental Aspects and Sleep Quality. Mousavi SH, Hijmans JM, Minoonejad H, Rajabi R, Zwerver J. Journal of Sports Science & Medicine. 2021;20(2):204-215. doi:10.52082/jssm.2021.204.

  15. Predictive Effect of Well-Known Risk Factors and Foot-Core Training in Lower Limb Running-Related Injuries in Recreational Runners: A Secondary Analysis of a Randomized Controlled Trial. Suda EY, Watari R, Matias AB, Taddei UT, Sacco ICN. The American Journal of Sports Medicine. 2022;50(1):248-254. doi:10.1177/03635465211056329. 

  16. Running With Injury: A Study of UK Novice and Recreational Runners and Factors Associated With Running Related Injury. Linton L, Valentin S. Journal of Science and Medicine in Sport. 2018;21(12):1221-1225. doi:10.1016/j.jsams.2018.05.021.

  17. Injuries Among Spanish Male Amateur Soccer Players: A Retrospective Population Study. Herrero H, Salinero JJ, Del Coso J. The American Journal of Sports Medicine. 2014;42(1):78-85. doi:10.1177/0363546513507767. 

  18. Soccer Injuries and Recovery in Dutch Male Amateur Soccer Players: Results of a Prospective Cohort Study. van Beijsterveldt AM, Steffen K, Stubbe JH, et al. Clinical Journal of Sport Medicine : Official Journal of the Canadian Academy of Sport Medicine. 2014;24(4):337-42. doi:10.1097/JSM.0000000000000028. 

  19. Injuries in Formal and Informal Non-Professional Soccer - An Overview of Injury Context, Causes, and Characteristics. Gebert A, Gerber M, Pühse U, et al. European Journal of Sport Science. 2018;18(8):1168-1176. doi:10.1080/17461391.2018.1475507. 

  20. The Perils of Pickleball: A Two Decade Analysis of Upper and Lower Extremity Injuries From America's Fastest Growing Sport. Boroumand S, Park N, Katsnelson B, et al. Journal of Sports Sciences. 2025;43(14):1378-1385. doi:10.1080/02640414.2025.2496089. 

  21. Pickleball-Related Injuries Treated in Emergency Departments. Forrester MB. The Journal of Emergency Medicine. 2020;58(2):275-279. doi:10.1016/j.jemermed.2019.09.016. 

  22. Injury Risk and Epidemiology of Pickleball Players in South Korea: A Cross-Sectional Study. Jeong B, Lee KJ, Nam SH, et al. Frontiers in Public Health. 2025;13:1617291. doi:10.3389/fpubh.2025.1617291. 

  23. Pickleball: A Standard Review of Injury Prevalence and Prevention in a Rapidly Growing Sport. Azar FM, Lamplot JD, Bernholt DL, Spence DD. The Journal of the American Academy of Orthopaedic Surgeons. 2024;32(22):e1130-e1141. doi:10.5435/JAAOS-D-24-00151. 

  24. As Pickleball Continues to Gain Players, Injuries Are Increasing. Rodgers L. JAMA. 2025;:2840448. doi:10.1001/jama.2025.18833. 

  25. Emerging Patterns of Foot and Ankle Injuries in Pickleball Players: A Short Report. Kingston K, Parker EB, Higgins A, Smith JT. Foot & Ankle International. 2024;45(11):1266-1269. doi:10.1177/10711007241271215. 

  26. Common Sports Injuries in Young Tennis Players. Bylak J, Hutchinson MR. Sports Medicine (Auckland, N.Z.). 1998;26(2):119-32. doi:10.2165/00007256-199826020-00005.

Getting Back Out There, The Right Way

Ever watch your star player go down with a knee injury, see a shoulder pop out during a tackle, or witness an ankle roll on the court? These moments are gut-wrenching for athletes, parents, and coaches alike. But here's the good news: most high school athletes can successfully return to their sport after these common injuries — if they follow the right roadmap for physical recovery.

Let's break down what it takes to get physically cleared for return to play after an ACL tear, shoulder dislocation, or ankle sprain.

 

The ACL Injury: A Marathon, Not a Sprint

An ACL tear is one of the most feared injuries in youth sports, and for good reason. Nearly a quarter of a million ACL injuries occur annually in the US and Canada, with rates in high school athletes reaching 5.5 per 100,000 athlete exposures. But here's what many don't realize: getting back on the field isn't just about healing — it's about meeting specific physical benchmarks.

The minimum timeline is 9 months from surgery, and that's not arbitrary. Your body needs time for the graft to incorporate biologically, and rushing back increases reinjury risk dramatically. In fact, athletes who returned before 9 months had significantly higher rates of reinjury compared to those who waited.

But time alone isn't enough. Athletes must achieve at least 90% limb symmetry index (LSI) for both quadriceps strength and hop testing before getting cleared for competition. This means the injured leg needs to perform at 90% or better compared to the uninjured leg. Athletes who met these criteria had a reinjury rate of just 4.5% within 2 years, compared to 33% in those who didn't meet the criteria.

The recovery follows a structured, mulit-phase approach:

  • Early phase (weeks 0-6): Focus on reducing swelling, restoring range of motion to 0-115 degrees, and achieving 60% quadriceps strength symmetry

  • Intermediate phase (weeks 7-9): Progress to 70% strength symmetry with full, symmetrical range of motion

  • Late phase (weeks 10-16): Reach 75-80% strength symmetry and begin running when you hit 80% and can demonstrate single leg squats, step downs and hops with good mechanics

  • Transitional phase (months 4-6): Introduce jumping, sprinting, and agility drills at 85% strength symmetry

  • Return-to-sport phase (months 6-12): Sport-specific training with final clearance requiring 90% symmetry, no pain or swelling, and adequate confidence levels

Here's the reality check: only 40-55% of athletes return to their pre-injury activity level after ACL reconstruction. Even among highly motivated European professional soccer players with excellent resources, only 65% returned to their previous level. This isn't meant to discourage — it's meant to emphasize the importance of working with a sports physical therapist and following a comprehensive plan.

 

Shoulder Dislocations: High Risk, But Quick Recovery Possible

The shoulder is the most commonly dislocated joint in the body, and it usually dislocates anteriorly (toward the front). For high school athletes, especially those in contact and collision sports, this injury comes with a sobering statistic: recurrence rates can reach up to 90% in active patients younger than 25 years.

But here's where shoulder dislocations differ from ACL injuries: return to play can happen as early as 2-3 weeks after injury for athletes who are pain-free, have symmetrical shoulder range of motion, and can perform sport-specific motions. Some athletes with recurrent dislocations who experience easy relocation, minimal pain, full range of motion, and protective strength may even return the same day.

The treatment approach depends on several factors:

Immediate management:

  • Attempted relocation on the field before muscle spasm develops

  • Neurovascular assessment before and after reduction

  • Immobilization and pain management after successful reduction

  • Post-reduction radiographs after first-time dislocation

Recovery protocol:

  • Sling use for 2-4 weeks for comfort (though current evidence doesn't mandate a specific duration)

  • Graduated rehabilitation focusing on passive and active range of motion

  • Physical therapy addressing joint range of motion, scapular control, rotator cuff strength, and sport-specific conditioning

Surgical considerations: Surgery should be considered for first-time dislocations in active patients under 25 due to the extremely high recurrence rate, or when there are complications like large bony defects.

Interestingly, research on high school athletes shows that 85% of those treated nonoperatively successfully returned to their sport and completed at least one full season without additional injury. Athletes with subluxations (partial dislocations) fared even better, with an 89% success rate compared to 26% for complete dislocations.

 

Ankle Sprains: The Most Common Culprit

Ankle sprains are the most common foot-ankle and sports-related injury for which people seek medical care. Four in every 10 first-time ankle sprains occur during sports participation. The good news? Most athletes bounce back quickly.!

High school athletes have a 75% chance of returning to sport within 3 days after a first-time , Grade I ankle sprain, and a 95% chance within 10 days. In college athletics, 44.4% of athletes returned to play in less than 24 hours. However, more severe Grade II and III sprains involving multiple ligaments can sideline athletes for more than 3 weeks.

The key to successful return involves addressing five critical domains — the PAASS framework:

  • Pain: Both during sport participation and over the last 24 hours

  • Ankle impairments: Range of motion, muscle strength, endurance, and power

  • Athlete perception: Confidence, reassurance, stability, and psychological readiness

  • Sensorimotor control: Proprioception and dynamic postural control/balance

  • Sport/functional performance: Hopping, jumping, agility, sport-specific drills, and ability to complete a full training session

Supervised exercise programs addressing strength, coordination, proprioception, and functional deficits lead to faster return to sports. Evidence also supports the use of compression stockings and anteroposterior ankle joint mobilization for quicker recovery.

General return-to-work and sport guidelines suggest:

  • Return to sedentary work: 2-6 weeks following injury

  • Return to physical occupations and sports: 6-8 weeks

These timelines should be adjusted based on injury severity, rehabilitation response, and specific task requirements. Working with a sports medicine clinician will be key for determining optimal readiness.

 

TOOLS FOR BUILDING CONFIDENCE

Resistance bands, balance pads and boards, and BFR cuffs are a few of the essential tools in rehabilitation. Resistance bands safely build strength, balance pads enhance coordination and stability, and BFR cuffs accelerate recovery through low-load training.

Below are our top 5 recommended products to use as a recovering athlete.

 
 

Click the image to shop on Amazon through our affiliate links and access possible discounts!

 
 

The Bottom Line

Physical clearance for return to play isn't one-size-fits-all. ACL injuries require the longest recovery with the most stringent criteria — minimum 9 months and 90% strength symmetry. Shoulder dislocations can allow quicker return (2-3 weeks) but carry high recurrence risk in young athletes. Ankle sprains typically resolve fastest, with most athletes back within days to weeks.

The common thread? Meeting objective physical criteria matters more than arbitrary timelines. Pain-free movement, symmetrical strength, full range of motion, and sport-specific performance capabilities aren't just checkboxes — they're your best insurance against reinjury.

In Part 2, we'll explore the mental side of return to play — because as we've learned, physical readiness is only half the battle.

 

References