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.

Mindset

Returning to Play for High School Athletes: Part 1

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

From Rehab to Resilience: The Power of Maintenance Massage

If you’ve ever received massage therapy as part of your physical therapy care, you’ve likely experienced the benefits of recovery massage—decreased soreness, improved mobility, and faster healing. But what happens when you’re out of the acute phase? That’s where maintenance massage comes in—and it’s often the missing piece in staying injury-free and performing at your best.

While recovery massage gets much of the spotlight in the rehab process, maintenance massage is what keeps your system tuned and functioning well long after the initial problem has resolved. Let’s explore the distinct purposes of recovery and maintenance massage, why each matters, and why transitioning from one to the other should be part of your long-term plan.



Recovery Massage: A Tool for Healing

Recovery massage is typically prescribed during or immediately after an injury or intense physical stress. It targets soft tissues that are healing or under high demand. The goals are straightforward: reduce pain, manage inflammation, improve circulation, restore function, and help tissue recover from overload.

Studies consistently show that massage therapy can play a meaningful role in post-injury and post-exercise recovery. A meta-analysis published in Frontiers in Physiology found that massage significantly reduces delayed-onset muscle soreness (DOMS) and improves muscle performance markers such as strength and range of motion after strenuous exercise (Davis et al., 2020). Similarly, massage has been found to be effective in reducing perceived fatigue and supporting muscle recovery without impairing strength or power output (Poppendieck et al., 2016).

Massage also appears to positively impact inflammatory and healing pathways. A cellular-level study by Crane et al. (2012) found that massage downregulated genes associated with inflammation and promoted mitochondrial biogenesis in muscle tissue following exercise. This means massage doesn’t just feel good—it may help tissues repair more efficiently.

In rehab settings, recovery massage often occurs multiple times per week, especially in the early stages of healing. Sessions are more targeted, focusing on restoring mobility and reducing compensation patterns. Once pain and mobility have improved, the frequency of sessions typically decreases, paving the way for a maintenance plan.



Maintenance Massage: Investing in Resilience

In contrast to recovery massage, maintenance massage isn’t about fixing something that’s broken—it’s about keeping systems running smoothly. After you successfully recover from injury, transitioning into maintenance massage is a key strategy to prevent recurrence and improve long-term performance and body awareness.

Maintenance massage supports:

  • Circulation and metabolic exchange in muscles and fascia

  • Muscle tone balance in frequently used or overused areas

  • Joint mobility and tissue pliability

  • Stress reduction and parasympathetic nervous system activation

Although fewer studies focus exclusively on maintenance massage, the benefits are supported by broader research into regular manual therapy. For example, research published in International Journal of Therapeutic Massage & Bodywork found that regular massage over four weeks led to statistically significant decreases in reported musculoskeletal discomfort in healthy adults (Sherman et al., 2014).

Importantly, maintenance massage isn't “less important” just because it's not addressing an acute injury. For athletes or active individuals, maintenance massage becomes part of an ongoing performance strategy—much like strength training or mobility work.

Frequency can vary: for highly active individuals, once every 2–4 weeks is common. The techniques used are often broader and less intense than during the recovery phase, with a focus on tissue health and function rather than symptom relief.





The Transition: From Recovery to Maintenance

One of the most important shifts in the rehabilitation process is knowing when and how to transition from recovery massage to maintenance. That shift usually happens once:

  • Pain has decreased

  • Normal movement patterns have returned

  • The tissue is no longer in an acute inflammatory state

  • Function has improved with activity or return to sport

At this stage, the goal is no longer just healing—it’s sustainability.

Yet many patients disengage from bodywork once the acute phase ends. They “graduate” from PT and stop getting massage until the next injury arises. This stop-start cycle can lead to setbacks or recurrent issues that were preventable with consistent maintenance work.

Massage therapists working in sports and rehab settings understand this arc and can guide the timing and frequency of maintenance sessions. Maintenance massage isn’t about pampering—it’s an active part of an athletic recovery strategy.

 

Tools We Trust for Recovery

While nothing replaces the benefits of hands-on massage, there are a few tools we consistently recommend. Products like massage guns, Chirp wheels, and the VenomGo—combining targeted heat and vibration—can help boost circulation and ease muscle tension between sessions.

 
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Conclusion: Recovery Is a Phase—Maintenance Is a Mindset

Recovery massage is the hero during an injury—focused, intensive, and essential. But as tissues heal and performance returns, the work doesn’t stop there. Maintenance massage picks up the baton, helping you maintain the progress you’ve made and avoid returning to square one.

For active individuals—especially those who’ve just completed physical therapy—making maintenance massage a consistent part of your recovery strategy helps build resilience, prevent injuries, and optimize performance. Just as your training evolves with your goals, so too should your approach to bodywork.

In short: Recovery massage gets you out of trouble. Maintenance massage keeps you out of it.

 

References

  • Crane, J. D., Ogborn, D. I., Cupido, C., Melov, S., Hubbard, A., Bourgeois, J. M., ... & Tarnopolsky, M. A. (2012). Massage therapy attenuates inflammatory signaling after exercise-induced muscle damage. Science Translational Medicine, 4(119), 119ra13. https://doi.org/10.1126/scitranslmed.3002882

  • Davis, H. L., Alabed, S., & Chico, T. J. (2020). Effect of sports massage on performance and recovery: A systematic review and meta-analysis. Frontiers in Physiology, 11, 748. https://doi.org/10.3389/fphys.2020.00748

  • Poppendieck, W., Wegmann, M., Ferrauti, A., Kellmann, M., Pfeiffer, M., & Meyer, T. (2016). Massage and performance recovery: A meta-analytical review. Sports Medicine, 46(2), 183–204. https://doi.org/10.1007/s40279-015-0420-x

  • Sherman, K. J., Cherkin, D. C., Kahn, J., Erro, J. H., Hrbek, A., Deyo, R. A., & Eisenberg, D. M. (2014). A survey of training and practice patterns of massage therapists in two US states. International Journal of Therapeutic Massage & Bodywork, 7(1), 10–17. https://doi.org/10.3822/ijtmb.v7i1.202

Finding Gratitude in Recovery


Setbacks, particularly injuries, suddenly make us realize everything we used to have. Our patients often share feelings of angry, frustration, regret and fear with us during their sessions. They often ask what they should have done, could have done better, to have avoided this outcome. But ultimately, injuries happen, even to the most prepared.

Losing, Better

We set big goals around here. When an injury occurs, it can feel like a failure. It’s challenging emotionally to cope with the loss of everything you’ve already invested in this season. For those of you on teams, this adds an extra layer of guilt and distress. Author Steve Magness outlines a plan he calls “How to Lose Productively” that translates to injury recovery.