Post-Rehab Pitfalls: 5 Mistakes That Will Derail Your Return to Sport

Physical therapy got you out of the hole. Your pain is down, range of motion is returning, and basic strength is back online. But sport is chaos: speed, bodies, late decisions, weird angles, and fatigue. That’s where mechanics break down and injuries happen. A smart Return to Sport (RTS) plan bridges that gap.

Too many comebacks go sideways because people mistake "clinically normal" for "game ready." There's a real gap between feeling fine in a controlled PT setting and absorbing force, cutting hard, and reacting at full speed. That gap is exactly where re-injuries live.

Here are five mistakes that derail comebacks, as well as how to avoid them:

Mistake 1: Chasing the Calendar, Not Capacity

The mistake: Circling a date (like “six months out” or “season opener”) and forcing your body to match it.

Why it's a problem: Fully rehabbing an injury means building tissue capacity—your body's ability to handle load—that can withstand what your sport throws at you. But that capacity doesn't care about your schedule. Coming back early, especially after major ligament injuries, spikes your odds of getting hurt again.

The research is clear: young athletes who returned to knee-demanding sports before 9 months after ACL reconstruction had roughly seven times the rate of new ACL injury compared to those who waited at least 9 months (15). On the flip side, one study found that delaying return until athletes hit strength and hop thresholds was linked to an 84% reduction in second-injury risk (10). That's not caution for caution's sake—that's math.

How we do it: At Landow Performance, we anchor return-to-sport on hard criteria, not dates. That means testing strength, jumping ability, landing quality, and differences between limbs—plus progressive exposure to game-speed chaos. If you haven't earned the next phase, you don't advance. Every month of smart prep (up to 9 months in the research) buys you more safety. Some athletes need even longer, and that's okay.

Mistake 2: Chasing Numbers Before You Own Positions

The mistake: Obsessing over output (bar speed, jump height, sprint times) before you own positions (knee, hip, trunk, and foot control).

Why it's a problem:

Building capacity matters, but that capacity needs to be expressed through sound movement. Poor movement quality means bad positions under load—and bad positions drive re-injury risk. Research shows that athletes who land with their knees caving in (dynamic valgus) are more likely to tear their ACL down the road (2).

Why do athletes end up in bad positions? Could be years of bad habits, poor body awareness, fatigue—you name it. Limited ankle mobility is a big one: if you can't bend your ankle enough, you can't absorb shock properly when you land (11).

Here's the sneaky part: athletes can often "pass" basic tests and still move poorly. One study found that post-ACL athletes who met return-to-sport criteria were actually hitting symmetry by reducing total output, not by restoring normal mechanics (8). They looked balanced on paper but weren't moving well.

How we do it: “Do ordinary things extraordinarily well.” We earn output through position → pattern → power. That means ankle mobility, foot control, clean knee tracking, and trunk discipline before we add load and speed. Nail the landing "stick" work and controlled lowering before you get to bounce and blast. When positions are clean, outputs climb and risk falls.

Mistake 3: Skipping Force "Absorption" and Deceleration

The mistake: Training your "go" (acceleration, jumps, top speed) but not your "stop" (braking, landing, change of direction).

Why it's a problem: Most non-contact injuries happen when athletes are slowing down or changing direction, not speeding up. Deceleration is brutally demanding on soft tissue and joint control. The research is catching up to what good coaches already know: deceleration is a trainable skill, and most programs ignore it (12, 13). If you never train to absorb force, especially when you're tired, your brakes fail right when you need them most.

How we do it: We treat deceleration as a trainable skill, not an afterthought. The progression: snap-downs → controlled acceleration to clean stops → change-of-direction work emphasizing braking mechanics → reactive cuts under fatigue. Eccentric strength (quads, hamstrings, calves) and landing quality are non-negotiables before we let you sprint and cut at full speed.

Mistake 4: Dosing Plyometrics Wrong (Too Much, Too Soon… or Forever Too Easy)

The mistake: Going straight to high-impact depth jumps or bounds too early, or staying on "rehab lite" exercises like pogo hops forever.

Why it's a problem: Plyometrics rebuild elastic power, but they also place high demands on your bones, cartilage, and tendons. Here's the thing to remember: tendons adapt slower than muscle. Ramp up intensity or volume too fast, and you're inviting tendinopathy or flare-ups (5). The research says to progress gradually and match exercises to readiness (3, 7).

But the opposite mistake is just as common. If you never progress beyond low-level hops, you're underprepared for game-level ground reaction forces. You need to earn the hard stuff, but you still do need to get there eventually.

How we do it: We follow a clear plyometric progression: competent landings and static holds → low-amplitude hops → faster rebounds → single-leg and reactive work → depth jumps and high-intensity tasks. Volume and intensity are planned out; we watch quality first, then adjust dosage. And you need to earn your deceleration skills (see Mistake #3) before you get to the spicy stuff.

Mistake 5: Skipping the Full Test Battery (“Testing Debt”)

The mistake: Feeling "pretty good" and skipping comprehensive testing: strength, hops, landing quality, speed, agility, and confidence surveys.

Why it's a problem: Decisions made by vibe miss hidden deficits. Research consistently shows that return-to-sport decisions should be based on multiple domains (strength, jumping, movement quality, and how you feel), not just one metric (8, 9). Yet only a small percentage of athletes actually meet the common 90% symmetry thresholds across all tests, even 6–24 months after ACL surgery (1).

Two classic traps:

1. The symmetry blind spot: If both legs are weak, 90% symmetry still isn't good enough for sport (6).
2. Masking with performance: You can hit hop distances but still show sketchy mechanics—altered landings, weird force patterns (8).

Your "good" leg often isn't as good as you think, either. Testing debt comes due in games, usually as a re-injury.

How we do it: “Don’t guess. Assess.” We clear athletes with multiple pieces of evidence: strength testing, single- and multi-hop series with quality scoring, jump assessments, change-of-direction tests, and how you actually feel. We look at absolute standards, not just % symmetry. If a box isn't checked, you're not "failed"—you're just not done yet. We close the gap, then progress.

The Bottom Line

Here's the deal: give yourself the time you actually need. Own your positions before you chase numbers. Train your brakes as hard as your gas pedal. Earn your plyos. And don't just guess—test.

Landow Performance's north star is simple: longevity. We're building athletes who can absorb, redirect, and produce force at game speed today, next month, and next season.

The fastest way back is still the smartest way back.

References

(1) A minority of athletes pass symmetry criteria in a series of hop and strength tests irrespective of having an ACL reconstructed knee or being noninjured. Orthopaedic Journal of Sports Medicine (2022). PubMed: https://pubmed.ncbi.nlm.nih.gov/35762123/ 

(2) Biomechanical measures of neuromuscular control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes: a prospective study. The American Journal of Sports Medicine (2005). PubMed: https://pubmed.ncbi.nlm.nih.gov/15722287/ 

(3) Current concepts of plyometric exercise. International Journal of Sports Physical Therapy (2015). PMC: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4637913/ 

(4) Deficits in contralateral limb strength can overestimate limb symmetry index following ACL reconstruction. Clinical Biomechanics (2022). PMC: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9596901/ 

(5) From mechanical loading to collagen synthesis, structural changes and function in human tendon. Scandinavian Journal of Medicine & Science in Sports (2009). PubMed: https://pubmed.ncbi.nlm.nih.gov/19706001/ 

(6) Limb Symmetry Indexes can overestimate knee function after ACL injury. The American Journal of Sports Medicine (2017). PubMed: https://pubmed.ncbi.nlm.nih.gov/28355978/ 

(7) Methodological considerations for determining the volume of drop jump training: A systematic review. Sports Medicine – Open (2023). PMC: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10160442/ 

(8) Passing return-to-sport criteria and landing biomechanics in young athletes following anterior cruciate ligament reconstruction. Journal of Orthopaedic Research (2022). PubMed: https://pubmed.ncbi.nlm.nih.gov/34081370/ 

(9) Return-to-Sport Criteria After Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-Analysis. Sports Health (2023). PMC: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9842113/ 

(10) Simple decision rules can reduce reinjury risk by 84% after ACL reconstruction: the Delaware-Oslo ACL cohort study. The American Journal of Sports Medicine (2016). PMC: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4912389/ 

(11) The association of dorsiflexion flexibility on landing mechanics associated with ACL injury. International Journal of Sports Physical Therapy (2016). PMC: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4977993/ 

(12) The deceleration index—Is it the missing link in rehabilitation? International Journal of Sports Physical Therapy (2023). PMC: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10069389/ 

(13) The effect of training interventions on change of direction biomechanics associated with the risk of lower-extremity injury: A systematic review. Sports Medicine (2019). PMC: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6851221/ 

(14) The effects of mid-flight whole-body and trunk rotation on knee biomechanics during the landing phase of a drop vertical jump. Journal of Orthopaedic Surgery and Research (2019). PMC: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6776723/

(15) Young athletes who return to sport before 9 months after anterior cruciate ligament reconstruction have a rate of new injury 7 times that of those who delay return. Journal of Orthopaedic & Sports Physical Therapy (2020). PubMed: https://pubmed.ncbi.nlm.nih.gov/32005095/