Forte Physical Therapy

🚨 Do NOT return to sport after a shoulder dislocation until you pass these 5 tests.
This applies to non-surgical shoulder dislocations.
Feeling better ≠ being ready. Athletes who return too soon after a first-time shoulder dislocation have some of the highest re-injury rates in sports medicine.
Before testing, we want:
✅ Full, pain-free shoulder ROM
✅ Negative apprehension testing
The 5 tests:
1️⃣ Timeline
• Minimum 12 weeks post-injury before RTS testing
2️⃣ Rotator Cuff Strength @ 90° Abduction
• IR >30% BW
• ER >20% BW
• 95-100% symmetry
3️⃣ Countermovement Push-Up
• Tolerated pain-free
• ≥90% symmetry in peak power
• ≥90% symmetry in braking impulse
4️⃣ Upper Body Strength & Power
• Push Press: Males >75% BW, Females >50% BW
• Med Ball Throws: ≥90% symmetry
• Drop Catch Rows: Males >60% BW, Females >40% BW
5️⃣ Sport-Specific Testing
• Progress from controlled drills → reactive drills → full-intensity sport
Returning safely requires more than pain-free movement. Your shoulder must prove it can produce force, absorb force, and tolerate the specific demands of your sport.

Avoiding leg extensions after ACL surgery is outdated advice.

The concern is that leg extensions place too much strain on the ACL graft. However, research shows there is little to no ACL strain between 90° and ~45° of knee flexion, with meaningful strain only occurring near full extension.

Studies have also shown that leg extensions produce only about 3.8% ACL strain, compared to up to 14% during normal walking, an activity commonly started immediately after surgery.

Most importantly, patients who perform appropriately prescribed leg extensions early after ACL reconstruction demonstrate better quadriceps strength and functional outcomes, without increased graft laxity.

Why does this matter? Quadriceps weakness remains the biggest deficit after ACL surgery. While squats, split squats, and step-ups are valuable, they allow compensation from other muscle groups. Leg extensions provide a direct, measurable way to load the quadriceps, especially during the early stages of rehab when strength loss occurs rapidly.

The goal isn’t just to protect the graft. It’s to restore strength, function, and long-term outcomes. Current evidence suggests leg extensions can play an important role in doing exactly that.

Do NOT rush into ACL surgery before attempting the Delaware-Oslo Coper Criteria.

The Delaware-Oslo Coper Criteria is a screening tool used to determine whether an individual may be able to return to a Level 1 sport without ACL reconstruction surgery.

Before being classified as a potential coper, you must first complete a minimum of 5 weeks of neuromuscular and strength training. In some cases, it can take up to 1 year to meet the classification criteria.

To be classified as a coper, you must achieve:

✅ Greater than 80% on the Knee Outcome Survey (KOS)

✅ Less than or equal to 1 episode of knee giving way during activity
This demonstrates the ability to maintain knee stability despite ACL deficiency.

✅ Greater than 60% on the Global Rating Scale of Knee Function

✅ Greater than 80% limb symmetry on hop testing
This demonstrates the injured knee can perform at a majority of the capacity of the uninjured side.

Important: Passing the Delaware-Oslo Coper Criteria does NOT mean you are ready to return to sport. It simply determines whether you qualify to continue progressing through rehabilitation with the goal of returning to a Level 1 sport.

For sports such as soccer, football, and basketball, athletes should still progress through comprehensive return-to-sport rehabilitation and demonstrate:

- Greater than 90% quadriceps strength symmetry
- Drop jump RSI > 1.3 m/s
- Single-leg drop jump RSI > 0.5 m/s
- Triple hop distance > 2.7x body height for men and > 2.5x body height for women. AND Greater than 90% limb symmetry index.
- Tolerance to full-speed reactive change-of-direction drills in a sport-specific environment

At any point, episodes of instability or knee giving way may result in reclassification as a non-coper.

Whether you ultimately return without surgery or proceed with ACL reconstruction, completing high-quality rehabilitation is essential. If surgery is required, you will enter the procedure stronger, more prepared, and with a better foundation for recovery.

Work closely with a physiotherapist experienced in strength & conditioning and return-to-sport testing to determine the best path for your individual situation.

Do not return to sport after ACL surgery until you pass these 5 milestones 👇

1️⃣ Minimum 9 months post-op
Returning before 9 months = up to 7x higher re-rupture risk ⚠️

2️⃣ Quad strength symmetry ≥90%
Less than 90% symmetry = 1/3 chance of re-tearing ‼️
PLUS: strength should be >0.7x bodyweight per leg to avoid “false symmetry” from a weak uninvolved side.

3️⃣ Triple Hop Test Distance
Men: ≥2.8x body height distance
Women: ≥2.5x body height distance
AND ≥90% limb symmetry index.

4️⃣ Reactive Strength Testing
Double leg drop jump RSI >1.3 m/s
Single leg drop jump RSI >0.5 m/s
Your knee needs to absorb + produce force quickly for cutting, sprinting, and change of direction.

5️⃣ Sport-specific change of direction testing
You should be able to perform reactive 90° and 180° cuts/pivots with NO pain, instability, or hesitation.

Kyritsis et al (2016) found that athletes that did not meet objective functional discharge criteria had a 4x greater ACL re-rupture rate.

ACL return-to-sport decisions should be based on objective testing not JUST timelines.

Stop chasing the “one exercise” that’s supposed to magically fix your knee pain!!!

Knee pain isn’t one size fits-all. Your pain could be coming from:
• Hip mobility restrictions
• Limited ankle mobility
• Tendon overload
• Meniscus or ACL injuries
• Stress fractures or acute trauma

And every one of those requires a different approach.

That’s why generic online advice often fails… because treating knee pain properly means understanding the ROOT cause first.

The right rehab program should be built around YOUR body, YOUR injury, and YOUR goals.

If you’re tired of guessing and want a plan tailored specifically to you, send us a message or visit our booking page.

Let’s get you back to moving pain-free 🏋🏻

🏃‍♂️ Don’t return to running after ACL surgery until you pass these key milestones:

1️⃣ Timeline: Minimum 3 months post-op
Returning to running before 3 months, or without sufficient knee function, increases your risk of re-injury and delays proper healing.

2️⃣ Quad strength testing
This objectively measures quad strength specifically and helps eliminate compensation from the hip extensors or other muscle groups.

3️⃣ 30-second sit-to-stand test
This assesses knee strength endurance and your ability to maintain control through repetitive flexion/extension cycles — critical for the demands of running.

4️⃣ 1.25x bodyweight split squat
This ensures you have adequate dynamic strength and lower body control before returning to impact activity.

5️⃣ 30cm single-leg depth drop
This measures your ability to absorb force and decelerate upon landing, which is essential for the repetitive impact involved in running.

Skipping these milestones can significantly increase your risk of injury.

If you need help rehabbing your ACL injury, send us a DM or visit the booking page in our bio 📩

How many times did you spot LeBron? 👀
***

Rolled your ankle recently?

Rest alone isn’t enough.

Research shows that early, progressive loading leads to better long-term outcomes and reduces your risk of re-injury.

In this video, we walk through 4 tests you should be able to pass before returning to sport. These cover things like strength, stability, and your ability to handle impact, because feeling “fine” isn’t the same as being ready.

Up to 40% of ankle sprains turn into chronic instability, and a big reason is incomplete rehab or going back too soon.

At Forte, we make sure you’re actually ready for the demands of your sport by building back stronger than before.

We test. We don’t guess.

It’s not about how many racks.
It’s about how they’re used.

Whether you need rehab or performance training, we’ve got you covered at Forte Physical Therapy & Performance.

Our skilled clinicians and coaches work under the same roof
bridging the gap from injury to high performance
so you don’t miss a beat.

Rehab here.
Train here.
Get stronger here, even while injured.

Stress less. Focus on what matters.