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Shoulder Stabilisation and Bankart Repair: Your Path Back to Sport

Shoulder Stabilisation and Bankart Repair: Your Path Back to Sport

by | May 19, 2025 | Return to Sport, Shoulder, Sports Injury, Surgery

Recovering from a shoulder stabilisation surgery, particularly a Bankart repair, can feel like navigating a winding trail. At Praxis Physiotherapy, we understand that athletes don’t just want to heal – they want to return stronger, more confident, and ready for action. This blog explores the key milestones in overhead and contact sport rehabilitation and the compelling evidence that supports structured physiotherapy.

Understanding Shoulder Stabilisation and Bankart Repair

The Bankart repair is a surgical intervention for traumatic anterior shoulder dislocations, which are most common in young, active populations – particularly those involved in contact or overhead sports. This procedure reattaches the torn labrum to the glenoid, restoring joint stability. While the surgery addresses structural instability, it is only the first step. Rehabilitating the shoulder to perform under high-stress, dynamic sporting conditions is where physiotherapy becomes crucial (Coyle et al., 2022).

 

Rehabilitation Phases: Beyond the Basics

Rehabilitation after Bankart repair generally progresses through four overlapping phases:

1. Protection & Early Mobility (0–6 weeks)

Initial goals include reducing pain and inflammation while protecting the repair. Gentle passive and assisted range-of-motion exercises begin, with sling use gradually tapered.

2. Strength Building (6–12 weeks)

Isometric and light resistance training begins. Scapular control and rotator cuff strengthening are vital. Coyle et al. (2022) found wide variability in when strengthening begins, from 1 to 12 weeks, underscoring the importance of tailored plans.

3. Advanced Control & Load Tolerance (12–20 weeks)

This phase introduces overhead activity simulation, plyometrics, and proprioceptive drills. Neuromuscular training improves shoulder resilience, especially under rapid direction changes and contact stress (Ialenti et al., 2017).

4. Return to Sport (20+ weeks)

Athletes progressively re-engage in sport-specific drills, initially non-contact, then full-contact scenarios. Full return to competitive play often occurs around 5–6 months, but timelines vary based on sport demands (Kasik et al., 2019).

 

The Evidence: Why Physiotherapy Matters

  • A systematic review by Rossi et al. (2021) revealed that 27% of athletes failed to return to sport post-surgery. Most cited fear of reinjury, not physical limitation, as the main barrier. Targeted rehab can address both physical readiness and confidence.
  • Kim et al. (2023) showed that factors such as shoulder strength, proprioception, and psychological readiness were predictive of successful return. Structured physiotherapy addresses all three.
  • The American Journal of Sports Medicine confirms that progressive loading, especially for overhead and contact tasks, enhances long-term outcomes and reduces recurrence rates (Kim et al., 2023).
  • Alsomali et al. (2021) and Stone & Pearsall (2014) agree that sport-specific milestones are crucial, with a general return-to-contact timeline of 16–24 weeks depending on the sport.

Back in the Game: What Sets Our Approach Apart

At Praxis Physiotherapy, our shoulder rehabilitation programs don’t just follow protocols – they evolve with the athlete. We incorporate evidence-based practices and tailor each phase to your sport, position, and performance goals. Whether you’re a rugby forward or a volleyball setter, our rehab plan adapts to your demands.

We emphasise:

  • Early and progressive exposure to overhead mechanics
  • Integrated neuromuscular training for dynamic stability
  • Gradual and safe return-to-contact drills
  • Psychological readiness assessments to overcome fear of reinjury

 

Summary Timeline for Return to Sport

Phase Timeframe Focus
Protection & Early Mobility 0–6 weeks Pain control, protected motion
Strength & Motor Control 6–12 weeks Rotator cuff & scapular strengthening
Overhead & Contact Prep 12–20 weeks Plyometrics, proprioception, advanced drills
Return to Sport 20–26+ weeks Gradual return to contact and full intensity

Final Thoughts: Your Comeback Starts with the Right Team

Recovering from shoulder stabilisation surgery is not just about healing – it’s about coming back better. Evidence clearly shows that structured, progressive physiotherapy is essential for returning to sport safely and confidently.

At Praxis Physiotherapy, we’re here to guide that journey every step of the way. If you are ready to get started, book online today.

Until next time, Praxis What You Preach…

📍 Clinics in Teneriffe, Buranda, and Carseldine

💪 Trusted by athletes. Backed by evidence. Here for everyone.

References
  • Coyle, M., Jaggi, A., Weatherburn, L., Daniell, H., & Chester, R. (2022). Post-operative rehabilitation following traumatic anterior shoulder dislocation: A systematic scoping review. Shoulder & Elbow, 15(5), 554–565.
  • Ialenti, M. N., Mulvihill, J. D., Feinstein, M., Zhang, A. L., & Feeley, B. T. (2017). Return to play following shoulder stabilization: A systematic review and meta-analysis. Orthopaedic Journal of Sports Medicine, 5(9)
  • Kasik, C. S., Rosen, M. R., Saper, M. G., & Zondervan, R. L. (2019). High rate of return to sport in adolescent athletes following anterior shoulder stabilisation: A systematic review. Journal of ISAKOS, 4(1), 43–50.
  • Kim, M., Haratian, A., Fathi, A., Kim, D. R., Patel, N., Bolia, I. K., … & Weber, A. E. (2023). Can we identify why athletes fail to return to sports after arthroscopic Bankart repair? A systematic review and meta-analysis. The American Journal of Sports Medicine, 51(9), 2480–2486.
  • Rossi, L. A., Tanoira, I., Brandariz, R., Pasqualini, I., & Ranalletta, M. (2021). Reasons why athletes do not return to sports after arthroscopic Bankart repair: A comparative study of 208 athletes with minimum 2-year follow-up. Orthopaedic Journal of Sports Medicine, 9(7)
  • Alsomali, K., Kholinne, E., Nguyen, T. V., Cho, C.-H., Kwak, J.-M., Koh, K.-H., & Jeon, I.-H. (2021). Outcomes and return to sport and work after open Bankart repair for recurrent shoulder instability: A systematic review. Orthopaedic Journal of Sports Medicine, 9(10)
  • Stone, G. P., & Pearsall, A. W. (2014). Return to play after open Bankart repair: A systematic review. Orthopaedic Journal of Sports Medicine, 2(2),
ACL Reconstruction Rehab – Week-by-Week Recovery Guide with Praxis Physio

ACL Reconstruction Rehab – Week-by-Week Recovery Guide with Praxis Physio

by | May 17, 2025 | ACL, Knee, Return to Sport, Sports Injury

Overview

ACL reconstruction surgery marks the beginning of a structured rehabilitation journey. At Praxis Physiotherapy, located in Teneriffe, Carseldine, and Buranda, we provide an evidence-based approach to guide patients from surgery to sport. Backed by over a decade of experience with football teams across Brisbane and collaborative ties with local knee surgeons, our programs are scientifically informed and results-driven.

Research has shown that a phased, criterion-based rehab plan reduces complication rates and improves return-to-sport outcomes (Shelbourne & Nitz, 1990). The following week-by-week overview reflects current best practice from leading ACL rehab literature.

Week-by-Week ACL Rehab Milestones

Prehab: Starting Strong Before Surgery

If you’re waiting for ACL surgery and your knee has no complicating factors like meniscal locking, there’s good evidence that doing some early rehab — before going under the knife — can significantly improve your recovery trajectory. This phase, often called “prehab,” aims to reduce swelling, restore full knee extension, activate the quadriceps, and build general lower limb strength.

Research shows that patients who enter surgery with better quadriceps strength and full range of motion recover faster and regain function more effectively post-operatively (Eitzen et al., 2010). In fact, one study in the British Journal of Sports Medicine found that even just 5 sessions of targeted prehab improved early post-op outcomes like walking speed, strength, and self-reported function (Failla et al., 2016).

Weeks 0–2: Pain, Protection, and Range

Early rehabilitation begins with swelling and pain management, protection of the graft, and restoration of knee extension. Controlled range-of-motion (ROM) exercises and quadriceps activation, particularly of the vastus medialis, are prioritised. Patients often use crutches to maintain safe gait patterns. Early introduction of blood flow restriction (BFR) training supports muscle maintenance without joint overload (Zazirnyi et al., 2020).

Checkpoint: Achieve full extension and minimal swelling by Week 2.

Weeks 2–6: Regain Motion and Begin Strength

Once inflammation is controlled, attention shifts to regaining full ROM, normalising walking gait, and initiating basic strength exercises such as mini-squats and heel raises. Use of closed kinetic chain exercises is supported for their functional benefit and reduced joint stress (Awad et al., 2017).

Checkpoint: Full ROM with independent walking and neuromuscular control.

Weeks 6–12: Strength Foundation

Patients now begin progressive resistance training using clinic gym equipment, including leg presses, Romanian deadlifts, and lunges. Core strength and dynamic control are emphasised. Light cardio via cycling or elliptical may be introduced. Pilates reformers are utilised at Praxis for controlled joint loading and core development.

Checkpoint: Strength symmetry reaching 70% of non-injured leg; competent single-leg stance.

Weeks 12–20: Power and Plyometric Preparation

This phase involves development of reactive strength and neuromuscular readiness. Jump landing, eccentric hamstring training, and lateral movement patterns are introduced. Key focus is on building capacity for eventual cutting and pivoting movements.

Checkpoint: Successful hop tests, 80% limb symmetry, and controlled change-of-direction drills.

Weeks 20–36: Agility and Functional Sport Movements

Higher-level drills simulate sport-specific movements. Patients perform acceleration/deceleration tasks, direction changes, and reactive decision-making. Plyometrics are progressed in intensity and volume. According to Damian & Damian (2018), phase-specific drills improve psychological readiness and functional return to play (Damian & Damian, 2018).

Checkpoint: Limb symmetry >90% in strength and hop metrics.

Months 9–12: Return-to-Sport Preparation

This stage addresses psychological readiness and simulates sport-specific loading. Functional and fatigue testing are conducted, often including contact drills. Clearance depends on achieving objective strength and control measures (Shelbourne & Patel, 1996).

Checkpoint: Refer for return-to-sport testing (detailed in a separate blog).

Practical Insights for Patients

ACL rehab can be a long and often isolating journey. Many patients report psychological challenges, especially during the early and middle stages when progress may feel slow. At Praxis, we recognise that motivation is a vital part of recovery. Our goal isn’t just to return you to pre-injury levels — it’s to help you become a more resilient, stronger athlete than before. Many ACL injuries stem from non-contact mechanisms linked to strength, control, and movement quality. By targeting these factors throughout rehab, we aim to reduce reinjury risk and elevate athletic performance in the long term.

ACL rehabilitation is about restoring whole-body function, not just healing a ligament. At Praxis Physiotherapy, we use a combination of BFR, Pilates reformers, and in-house rehab gyms to deliver tailored and progressive programs. Our partnerships with Brisbane’s knee specialists ensure timely updates and coordinated care transitions.

Why Brisbane Athletes Choose Praxis Physiotherapy

  • Proven protocols developed with elite Brisbane football teams
  • Direct lines of communication with top knee surgeons
  • BFR and Pilates integrated into post-op care
  • Ongoing strength and functional assessments across all phases

Conclusion

A structured, evidence-backed approach to ACL rehab dramatically improves recovery outcomes. At Praxis Physiotherapy, we offer a seamless, week-by-week program from day one post-op through to full sport readiness. Our comprehensive model ensures that Brisbane athletes receive the highest standard of care at every stage.

Until next time – Praxis What You Preach

📍 Clinics in Teneriffe, Buranda, and Carseldine

💪 Trusted by athletes. Backed by evidence. Here for everyone.

References

  1. Shelbourne, K.D., & Nitz, P. (1990). Accelerated rehabilitation after anterior cruciate ligament reconstruction. Am J Sports Med.
  2. Zazirnyi, I.M., et al. (2020). Our Point of View at Rehabilitation After ACL Reconstruction. Feofaniya Hospital.
  3. Damian, C. & Damian, M. (2018). Futsal Player Rehabilitation after ACL Reconstruction. Revista Românească.
  4. Awad, O.B. et al. (2017). A Systematic Review of ACL Reconstruction Rehabilitation. Egyptian Journal of Hospital Medicine.
  5. Shelbourne, K.D., & Patel, D.V. (1996). Rehabilitation after autogenous bone-patellar tendon-bone ACL reconstruction. JBJS Am.

From Pitch to Pressing: Leading the Way in Shoulder Pain Recovery

From Pitch to Pressing: Leading the Way in Shoulder Pain Recovery

by | May 10, 2025 | Return to Sport, Shoulder, Sport, Sports Injury

Understanding Rotator Cuff Pain in Active Populations

Shoulder pain, particularly rotator cuff (RC) injuries, is one of the most common complaints among athletes and active individuals. The rotator cuff, comprising the supraspinatus, infraspinatus, teres minor, and subscapularis, stabilises the shoulder and enables dynamic overhead movement. Athletes in cricket, tennis, AFL, and CrossFit are especially prone to strain this system through repetitive, high-load movements (Desmeules et al., 2025).

At Praxis Physiotherapy, we specialise in managing rotator cuff injuries with precision. Our expertise spans throwing athletes, tennis players at our Coops Club location, contact sports like AFL, and recreational CrossFit athletes — ensuring tailored care across sporting domains.

Tailored Treatment Backed by Clinical Evidence

Current guidelines recommend avoiding over-reliance on imaging and emphasize active rehabilitation. Many rotator cuff cases can be effectively managed without surgery, using structured, progressive rehab programs including resistance training, neuromuscular re-education, and load management (Desmeules et al., 2025).

Key strategies include:

  • Individualised education about the condition and recovery timeline
  • Isometric and isotonic strengthening of shoulder stabilizers
  • Use of validated outcome tools (e.g., handheld dynamometry, ROM apps) to track progress
  • Selective adjuncts, such as manual therapy or taping, when needed for short-term symptom relief

In persistent or complex cases, our close collaboration with shoulder and knee surgeon Dr. Kelly Macgroarty ensures a seamless escalation pathway and expert review.

man throwing yellow, blue, and red Mikasa ballThe Athletic Shoulder: Why Sport-Specific Rehab Matters

The demands placed on a shoulder in throwing or overhead sports are extreme. During a cricket bowl or tennis serve, angular velocities can reach 7000–7500°/s, and forces on the shoulder joint can exceed bodyweight (Wilk et al., 2009). These actions demand both mobility and stability—a balance referred to as the “thrower’s paradox.”

Our assessments go beyond the shoulder joint, considering the entire kinetic chain — from trunk control to hip mobility — to ensure optimal movement integration and minimize overload (Cools et al., 2021).

The Evidence on Rehabilitation & Prognosis

Recent guidelines emphasize exercise-based rehab as the most effective first-line intervention. Strength gains and symptom reduction are typically seen within 12 weeks if appropriately dosed (Desmeules et al., 2025). Furthermore, the longer pain persists, the lower the likelihood of full recovery from physiotherapy alone (Chester et al., 2013).

In terms of injury prevention, shoulder-focused warm-up programs — such as FIFA 11+, the Oslo Shoulder Program, and sport-specific throwing drills — have shown a moderate to large effect size in reducing injury risk (Liaghat et al., 2023).

Return to Sport: Measured, Not Rushed

Our return-to-sport protocols are designed to ensure both readiness and resilience. We use objective criteria:

  • Strength benchmarks (e.g. ER/IR ratio)
  • Symmetry comparisons
  • Fatigue tolerance testing
  • Sport-specific drills and reactive control

Whether you’re pressing overhead in a CrossFit WOD, tackling in AFL, or ramping up bowling loads in cricket, our protocols ensure a safe and confident return.

Prevention: Not an Afterthought

Our clinic philosophy incorporates injury prevention from the first session (PREVENT | PREPARE | PERFORM). For athletes at our Coops tennis facility, we screen for scapular dyskinesis and GIRD (glenohumeral internal rotation deficit). For CrossFitters, we optimise loading strategies and lifting technique.

Prevention is an ongoing cycle: screen, intervene, reassess. It’s not just about avoiding injury—it’s about building capacity and sustaining high performance (Cools et al., 2021).

Conclusion

Rotator cuff pain doesn’t have to be a long-term setback. With expert diagnosis, individualised rehab, and a sport-specific return plan, most athletes recover without surgery. At Praxis, we combine cutting-edge evidence with clinical experience — and our collaboration with orthopaedic surgeon’s and sports medicine practitioners means you’re in expert hands every step of the way. For more on throwing specifically, check out our blog where we put the Praxis team to the test!

Ready to take control of your shoulder pain? Book an appointment today and let our team guide you back to strength, confidence, and performance.

📍 Clinics in Teneriffe, Buranda, and Carseldine

💪 Trusted by athletes. Backed by evidence. Here for everyone.

References

  1. Desmeules, F. et al. (2025). Rotator Cuff Tendinopathy: Diagnosis, Nonsurgical Medical Care, and Rehabilitation: A Clinical Practice Guideline. Journal of Orthopaedic & Sports Physical Therapy, 55(4), 235–274.
  2. Wilk, K.E. et al. (2009). Shoulder Injuries in the Overhead Athlete. Journal of Orthopaedic & Sports Physical Therapy, 39(2), 38–54.
  3. Cools, A.M. et al. (2021). The Challenge of the Sporting Shoulder: From Injury Prevention Through Sport-Specific Rehabilitation Toward Return to Play. Annals of Physical and Rehabilitation Medicine, 64, 101384.
  4. Chester, R. et al. (2013). Predicting Response to Physiotherapy for Musculoskeletal Shoulder Pain: A Systematic Review. BMC Musculoskeletal Disorders, 14, 203.
  5. Liaghat, B. et al. (2023). Diagnosis, Prevention, and Treatment of Common Shoulder Injuries in Sport: Grading the Evidence. British Journal of Sports Medicine, 57, 408–416.
Strong Bones, Strong Runner: Understanding and Treating Stress Fractures

Strong Bones, Strong Runner: Understanding and Treating Stress Fractures

by | May 8, 2025 | Return to Sport, Running Injuries, Sports Injury

Understanding Stress Fractures in Runners: Risk, Recovery, and Prevention

Stress fractures are a frustrating reality for many runners. Characterised by small cracks or severe bone reactions due to repetitive load, these injuries can derail training for weeks or months, and in some cases, end seasons or careers. While they are most commonly associated with endurance sports like distance running, the underlying mechanisms are multifactorial and complex. This blog explores the current understanding of stress fractures in runners — including emerging research, rehabilitation strategies, and how to lower your injury risk.

What Is a Stress Fracture?

A stress fracture is a type of bone stress injury (BSI), an overuse injury caused by the accumulation of microdamage in bone tissue due to repeated loading. Unlike acute fractures that result from a single traumatic event, stress fractures occur when repetitive sub-threshold forces — like running — outpace the bone’s capacity to repair itself (Hoenig et al., 2022).

Bone is a dynamic tissue that remodels in response to stress. However, when this remodeling process cannot keep up with microdamage accumulation — due to either an increase in training load or inadequate recovery — bone strength deteriorates. This can progress from a stress reaction to a stress fracture and, if untreated, to a complete fracture (Bergman & Kaiser, 2025; Coslick et al., 2024).

Why Are Runners So Prone?

Running, by nature, imposes repeated high loads on the lower limbs. The tibia (shin bone), metatarsals, femur, and pelvis are frequent stress fracture sites in runners (Hadjispyrou et al., 2023). Several factors contribute to the elevated risk in this group:

  • Training Errors: Rapid increases in volume or intensity, excessive hill work, or high mileage without adequate rest periods.

  • Bone Geometry: Martin & Heiderscheit (2023) found associations between proximal femur geometry and increased stress fracture risk, suggesting that individual anatomical differences can affect how load is distributed through the skeleton.

  • Energy Deficiency: Low energy availability, often associated with disordered eating or high training demands, can impair bone remodeling and increase injury risk — particularly in female athletes.

  • Surface and Footwear: Hard surfaces, old or inappropriate shoes, and poor running biomechanics can all contribute to abnormal load distribution and localized bone stress.

High-Risk vs Low-Risk Locations

Not all stress fractures are created equal. According to Coslick et al. (2024), stress fractures are categorized based on location and associated risk of complications:

  • Low-risk sites (e.g., posterior tibia, fibula, second metatarsal shaft) typically heal well with conservative treatment.

  • High-risk sites (e.g., anterior tibia, navicular, femoral neck, and sacrum) are more likely to progress to non-union or full fracture and may require surgical management.

A nuanced understanding of the fracture location helps guide both treatment duration and rehabilitation intensity.

The Cumulative Risk Concept

Traditional models have viewed stress fractures as the result of isolated risk factors. However, Hamstra-Wright et al. (2021) propose a more integrated concept: the cumulative risk profile. This model acknowledges that risk factors — like energy deficiency, training load spikes, biomechanics, menstrual history, and previous BSIs — rarely occur in isolation.

In this framework, stress fractures occur when the athlete’s “load capacity” is exceeded by their “training load.” What’s striking is that two runners could follow the same training program but respond very differently based on their individual capacity, bone density, and recovery habits.

Clinically, this means runners must be assessed holistically. It also underscores the importance of individualized training plans, particularly during return-to-run phases.

Diagnosis and Imaging

Early symptoms of a stress fracture include localized pain that worsens with activity and settles with rest. As the injury progresses, pain can persist with walking or even at rest.

Unfortunately, standard X-rays often miss early bone stress injuries. MRI is the gold standard, able to detect bone marrow edema (early stress reaction) before a fracture line develops (Coslick et al., 2024; Bergman & Kaiser, 2025). Bone scans and CT can also be used in specific cases.

Rehabilitation and Return to Running

The cornerstone of stress fracture management is load reduction — typically involving rest from impact activities for 4–8 weeks depending on the site and severity. During this time, runners can usually continue cross-training (e.g., cycling, swimming) to maintain cardiovascular fitness.

A gradual return-to-run program should be guided by symptom response, starting with walk–run intervals and progressing to continuous running. Strength and conditioning plays a vital role in both rehabilitation and prevention — building muscular resilience to offload bony structures. Calf, hip, and core-focused strength work can significantly reduce recurrence risk and should form part of a comprehensive return-to-run strategy. (You can learn more about how we use strength and conditioning at Praxis Physiotherapy to support our runners here)

Coslick et al. (2024) emphasises the value of a multidisciplinary approach involving physiotherapists, sports physicians, dietitians, and coaches.

Preventing Stress Fractures: What Runners Can Do

While not all BSIs are preventable, runners can reduce their risk by addressing modifiable factors:

  • Progress training gradually: Avoid spikes in weekly mileage (>10% per week) and ensure at least one rest day.

  • Fuel adequately: Runners with low energy availability are at significantly increased risk, particularly females with menstrual disturbances.

  • Build strength: Muscle fatigue reduces shock absorption. Strengthening the calves, glutes, and trunk can reduce bone loading.

  • Check your shoes and form: Replace runners every 500–800 km and consider a running gait assessment, especially if you have a history of injury.

  • Listen to your body: Early symptoms like persistent aching, pinpoint bony pain, or pain that lingers after a run shouldn’t be ignored.

Emerging Insights: Bone Shape and Load Distribution

Martin & Heiderscheit’s (2023) biomechanical analysis highlights the role of pelvis and femoral geometry in modulating stress distribution through the lower limb. This helps explain why some runners — even those with ideal training habits — may still suffer stress fractures. Their work supports the growing trend of using 3D imaging and gait analysis in injury risk profiling.

The Bottom Line

Stress fractures in runners are complex, multifactorial injuries that require a careful balance of training load, nutrition, and recovery. While new imaging and biomechanics research has enhanced our ability to diagnose and understand them, the best approach remains holistic — considering both the runner’s physiology and their environment.

pair of blue-and-white Adidas running shoes

At Praxis Physiotherapy, we manage bone stress injuries in athletes of all levels. Whether you’re dealing with your first tibial stress reaction or a sacral stress fracture during marathon prep, we can help guide your recovery and reduce your future risk.

If you’re interested in how stress fractures affect other athletes — like fast bowlers in cricket — read our blog on lumbar spine stress fractures here.

Until next time, Praxis what you Preach

📍 Clinics in Teneriffe, Buranda, and Carseldine

💪 Trusted by athletes. Backed by evidence. Here for every body. 

References

Bergman, R., & Kaiser, K. (2025). Stress Reaction and Fractures. In StatPearls. StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK507835/

Coslick, A. M., Lestersmith, D., Chiang, C. C., Scura, D., Wilckens, J. H., & Emam, M. (2024). Lower extremity bone stress injuries in athletes: An update on current guidelines. Current Physical Medicine and Rehabilitation Reports, 12(1), 39–49. https://doi.org/10.1007/s40141-023-00456-6

Hamstra-Wright, K. L., Huxel Bliven, K. C., & Napier, C. (2021). Training load capacity, cumulative risk, and bone stress injuries: A narrative review of a holistic approach. Frontiers in Sports and Active Living, 3, 665683. https://doi.org/10.3389/fspor.2021.665683

Hadjispyrou, S., Hadjimichael, A. C., Kaspiris, A., Leptos, P., & Georgoulis, J. D. (2023). Treatment and rehabilitation approaches for stress fractures in long-distance runners: A literature review. Cureus, 15(11), e49397. https://doi.org/10.7759/cureus.49397

Hoenig, T., Ackerman, K. E., Beck, B. R., Bouxsein, M. L., Burr, D. B., Hollander, K., Popp, K. L., Rolvien, T., Tenforde, A. S., & Warden, S. J. (2022). Bone stress injuries. Nature Reviews Disease Primers, 8, 26. https://doi.org/10.1038/s41572-022-00352-y

Martin, J. A., & Heiderscheit, B. C. (2023). A hierarchical clustering approach for examining the relationship between pelvis–proximal femur geometry and bone stress injury in runners. Journal of Biomechanics, 160, 111782. https://doi.org/10.1016/j.jbiomech.2023.111782

ACL Rehabilitation: The Role of Physiotherapy in Returning to Life, Activity, and Sport

ACL Rehabilitation: The Role of Physiotherapy in Returning to Life, Activity, and Sport

by | Apr 22, 2025 | ACL, Gym and Strength, Knee, Return to Sport, Running Injuries

On today’s Praxis what you Preach, we cover a very common injury here in Australia – the Anterior Cruciate ligament (ACL) injury. At Praxis Physiotherapy, we understand that recovering from ACL reconstruction is more than just healing a knee — it’s about restoring confidence, movement, and returning to the activities and lifestyle that matter most to each person. Physiotherapists are uniquely placed to guide this journey from surgery through to return to everyday function, recreation, and sport.

What is an ACL Rupture?

The ACL is one of the key stabilising ligaments of the knee, crucial for controlling rotation and forward movement of the tibia. An ACL rupture typically occurs during sudden changes in direction, pivoting, or awkward landings — common in sports like AFL, soccer, basketball, and netball. It most often affects young, active individuals, particularly females, due to biomechanical and hormonal factors. While not all ACL injuries require surgery, those with complete ruptures who wish to return to cutting or pivoting sports usually undergo ACL reconstruction. Regardless of the surgical decision, structured rehabilitation guided by a physiotherapist is essential for a successful recovery and long-term knee health.

The Importance of Physiotherapy in ACL Rehab

Research shows that while around 80% of individuals return to some form of sport after ACL reconstruction, only 65% return to their preinjury level and just 55% to competitive levels (Andrade et al. 2020). Physiotherapy plays a vital role in improving these outcomes by guiding progressive rehabilitation and using structured criteria-based progressions.

Physiotherapy-led rehabilitation should begin early, with emphasis on knee mobilisation, weight-bearing as tolerated, and initiation of neuromuscular training (Andrade et al. 2020). The BJSM systematic review of clinical guidelines for ACL rehab supports early kinetic chain exercises (both open and closed), strength training, cryotherapy, and neuromuscular stimulation when indicated (Andrade et al. 2020).

From Healing to Performance: A Continuum

Recovery after ACL surgery should follow a continuum from impairment-based care to performance restoration. This includes early pain and swelling control, progressive strength and range of motion restoration, motor control retraining, and sport-specific preparation. At Praxis, we follow a phase-based rehabilitation model tailored to individual needs. These needs may include the type of surgical graft used, concurrent injury (e.g meniscus / MCL), the operating surgeon’s post-op protocols, the patient’s goals, sport-specific demands, timelines for return to competition, and previous levels of function — all of which require thoughtful and collaborative clinical decision-making.

Unfortunately, studies show that many patients are discharged before meeting strength or performance benchmarks — particularly in strength-focused exercises like the split squat, squat, or deadlift, which play a vital role in ACL rehab progression. For example, performing around 22 single-leg sit-to-stands is one such late-stage benchmark that reflects adequate quadriceps strength and control before return to sport (Welling et al 2018). Nichols et al. (2021) found that most published rehabilitation protocols emphasize endurance and hypertrophy without progressing to the strength or power needed to reduce reinjury risk. This underlines the need for physiotherapists to include high-intensity, sports specific strength training and late-stage performance metrics as patients near return to sport.

Addressing Muscle Atrophy and Weakness

Quadriceps atrophy remains a key barrier to recovery post-ACL reconstruction. Evidence supports adjunct interventions such as neuromuscular electrical stimulation and blood flow restriction (BFR) training to combat muscle loss, particularly in the early post-operative period (Charles et al. 2020). BFR combined with low-load resistance exercise has been shown to reduce muscle wasting and promote strength gains when higher loads are contraindicated — we explore this more in our Blood Flow Restriction Training blog. We use this frequently at Praxis Physiotherapy in both reformer pilates and early gym based settings. 

The Role of the Physio: More Than Just Exercise

Our job as physiotherapists goes beyond prescribing exercises. We support patients through the emotional and motivational challenges of recovery, address fear of re-injury, and help them develop the confidence to return to sport or physically demanding jobs. We tailor plans based on functional goals, sport-specific needs, and personal circumstances.

At Praxis, this also means working closely with coaches, GPs, surgeons, and families to ensure clear communication and aligned expectations. For sporting patients, this might include on-field rehab or comprehensive return-to-play assessments in collaboration with clubs and teams.

A Collaborative, High-Performance Rehabilitation Environment

At Praxis Physiotherapy, we bring high-performance rehab principles to all patients — not just elite athletes. Our team has provided physiotherapy services to the Aspley Hornets AFL Club since 2014, giving us deep insight into the physical and mental demands of competitive sport. We apply this same standard of care to everyday athletes, weekend warriors, and anyone seeking to return to an active lifestyle.

We also work closely with orthopaedic knee and shoulder surgeon Dr. Kelly Macgroarty, including in-room triage consulting, ensuring a seamlessly integrated, evidence-informed rehabilitation pathway. This collaboration allows us to align surgical timelines, post-op considerations, and physiotherapy progressions — from day one to return to sport.

Our clinical culture is shaped by exposure to elite-level sports environments, including AFL, representative athletics, and professional national cricket programs. But rather than highlight individual accolades, we’re most proud of the high clinical standards and systems-based approach that ensure our entire team delivers the same quality of care — no matter who walks through the door.

Each of our Brisbane based clinics includes access to gym facilities and reformer Pilates equipment, allowing for real-world, function-driven exercise. These resources support patients to not only recover structurally but also return to high levels of strength, coordination, and performance in line with the latest evidence-based guidelines.

A Message to Our Patients

Whether you’re an athlete aiming for competitive return or someone wanting to run after your kids again, we bring the same level of care and attention to your ACL rehab. Recovery is not just about timelines — it’s about building back strength, movement, and trust in your knee. Ready to get started with your own recovery plan? Explore the ACL physiotherapy services at Praxis and book an appointment today.

Until next time, Praxis What You Preach…

📍 Clinics in Teneriffe, Buranda, and Carseldine
💪 Trusted by athletes. Backed by evidence. Here for everyone.

For more insights into long-term knee health, including non-surgical rehab, check out our Knee Osteoarthritis blog.

References

Andrade R, et al. (2020). How should clinicians rehabilitate patients after ACL reconstruction? A systematic review of clinical practice guidelines. Br J Sports Med, 54(9), 512–519.

Kochman M, et al. (2022). ACL Reconstruction: Which Additional Physiotherapy Interventions Improve Early-Stage Rehabilitation? Int J Environ Res Public Health, 19(23), 15893.

Charles D, et al. (2020). A systematic review of the effects of blood flow restriction training on quadriceps muscle atrophy and circumference post ACL reconstruction. Int J Sports Phys Ther, 15(6), 882–889.

Nichols ZW, et al. (2021). Is resistance training intensity adequately prescribed to meet the demands of returning to sport following ACL repair? A systematic review. BMJ Open Sport Exerc Med, 7(1), e001144.

Welling W, Benjaminse A, Gokeler A, Otten E, & Seil R. (2018). Low rates of patients meeting return to sport criteria 9 months after anterior cruciate ligament reconstruction: a prospective longitudinal study. Knee Surg Sports Traumatol Arthrosc, 26(12), 3636–3644.

Ankle Sprains: Don’t Let a Simple Injury Turn into a Long-Term Problem

Ankle Sprains: Don’t Let a Simple Injury Turn into a Long-Term Problem

by | Apr 22, 2025 | Ankle and Foot, Return to Sport, Running Injuries

Ankle sprains are among the most common injuries we see at Praxis Physiotherapy. Whether you’re an AFL midfielder, a cricket fast bowler, or a weekend runner pounding the Brisbane River loop, lateral ankle sprains can derail performance and linger longer than they should.

At Praxis, we’ve rehabilitated hundreds of athletes across all levels, from juniors to pros. Our experience includes long-term roles with the Aspley Hornets AFL Club (since 2014), the Queensland Bulls, Australia A, and even the Australian Men’s Cricket Team. We bring these elite rehab principles to everyone — from sprained-ankle soccer kids to high-performance track athletes.

But despite how common they are, ankle sprains are often underestimated. Without proper rehab, they can lead to chronic ankle instability (CAI), impaired athletic performance, and even new injuries in other parts of the body.

What Actually Happens in an Ankle Sprain?

A lateral ankle sprain usually occurs when the foot rolls inward, stretching or tearing the ligaments on the outside of the ankle — most commonly the anterior talofibular ligament (ATFL). It often happens during sudden changes of direction, awkward landings, or stepping on uneven ground.

You might feel a pop or crunch, followed by swelling, bruising, and pain when walking or bearing weight. While it may seem like a “simple sprain,” it’s anything but — around 40% of people report long-term issues one year post-injury if not managed well​.

gray concrete statue of a man

Common Mistake: Rest, Ice, and… That’s It?

Too many people still follow the old R.I.C.E. (rest, ice, compression, elevation) model and assume the job is done. While these strategies can help in the first 48 hours, they’re far from sufficient for full recovery.

In fact, research has shown that inadequate rehab is a major contributor to chronic ankle instability — a condition marked by recurrent sprains, feelings of the ankle “giving way,” and reduced confidence in movement​.

CAI can lead to altered biomechanics and poor neuromuscular control, increasing the risk of knee injuries, Achilles tendinopathy, or even hip and low back pain due to compensation.

Proper Rehabilitation Is Key — Here’s What the Evidence Says

Rehabilitation needs to start early and be progressive. High-quality clinical guidelines and systematic reviews strongly support the following strategies:

Functional Support and Early Mobilisation

Functional bracing (like an ankle brace or taping) is preferred over rigid immobilisation and should be used for 4–6 weeks . Early weight-bearing as tolerated leads to quicker return to activity and better outcomes .

Exercise Therapy

Neuromuscular training (balance, proprioception, and strength work) is the foundation of successful rehab. It improves ankle control, prevents recurrence, and reduces the risk of CAI​. A wobble board, single-leg balance, hopping drills, and directional change exercises are all commonly used.

Manual Therapy

Joint mobilisations and soft tissue work may improve dorsiflexion range, decrease pain, and aid in functional recovery​. At Praxis, we combine manual therapy with functional retraining to fast-track performance readiness.

Individualised Return-to-Sport Testing

Return to sport shouldn’t be based on time alone. We use objective testing — including single-leg hop symmetry, balance tests, and strength assessments — to ensure you’re not returning with deficits that could increase your reinjury risk.

The Cost of Incomplete Rehab: What Happens If You Don’t Get It Right?

A rushed or poorly structured rehab may get you back to activity temporarily — but it opens the door to:

  • Chronic Ankle Instability (CAI): Repeated sprains, perceived instability, and loss of ankle confidence.

  • Performance Limitations: Reduced agility, speed, and power due to poor proprioception and strength deficits.

  • New Injuries: Compensatory patterns can lead to medial tibial stress syndrome (shin splints), Achilles overload, or even ACL risk due to poor landing mechanics.

In elite sport, we see this cascade far too often. That’s why our rehab at Praxis isn’t just about the ankle — it’s about restoring whole-limb function and confidence under pressure.

Prevention: Keep Your Ankles Bulletproof

At Praxis Physiotherapy, we don’t just treat ankle sprains — we help prevent them. Our prevention approach includes:

  • Regular Balance and Plyometric Training: Incorporating single-leg exercises into gym and field work.

  • Proprioceptive Work: Using wobble boards, balance mats, and directional hopping.

  • Footwear and Bracing Advice: Particularly for high-risk sports like netball, football, and athletics.

  • Pre-season Screening and Performance Testing: For our affiliated sports clubs and athletic populations.

Evidence supports proprioceptive training as a proven strategy to reduce ankle sprain incidence by up to 35% in high-risk athletes​.

Why Choose Praxis Physiotherapy?

Our exposure to elite sport has taught us what good rehab looks like — and we apply those same high standards to every patient. Our clinics are equipped with strength testing tools, reformer Pilates, and full gym access, giving you the tools to rebuild better.

We understand the mindset of athletes — from juniors chasing state squads to elite-level players returning from surgery. That’s why we tailor your program based on sport demands, movement patterns, and individual goals.

Whether you rolled your ankle playing touch footy or twisted it at work, we’re here to get you back — stronger, faster, and more confident than before.

Need Help with an Ankle Sprain?

If you’ve recently rolled your ankle or are dealing with ongoing instability, book a consultation at Praxis Physiotherapy. Let our team guide you through a structured rehab program grounded in sports science and elite clinical standards.

📍 Clinics in Teneriffe, Buranda, and Carseldine
💪 Trusted by athletes. Backed by evidence. Here for every body.

References

Ruiz-Sánchez et al. (2022). Management and treatment of ankle sprain according to clinical practice guidelines: A PRISMA systematic review. Medicine (Baltimore), 101(42)

Green et al. (2019). What is the quality of clinical practice guidelines for the treatment of acute lateral ankle ligament sprains in adults? BMC Musculoskeletal Disorders, 20(394)

Doherty et al. (2017). Treatment and prevention of acute and recurrent ankle sprain: an overview of systematic reviews with meta-analysis. BJSM, 51(2), 113–125.