How long does return to sport rehab take?

It depends on the injury. ACL reconstruction typically requires 9–12+ months before competition clearance with criteria-based testing. Muscle injuries like hamstring tears may be 6–12 weeks. We'll give you an honest timeline at your initial assessment.

Can I return to sport without surgery?

Yes — many injuries, including some ACL tears, can be managed conservatively with the right rehab. We'll assess your suitability and discuss the evidence-based options with you.

What does criteria-based return to sport mean?

It means you're cleared to return when you meet objective performance benchmarks — strength symmetry, power output, movement quality — not just when a set number of weeks have passed. This approach significantly reduces re-injury risk.

Do I need a referral for return to sport physiotherapy?

No referral needed. You can book directly online. If you have imaging or surgical reports, bring them along.

Movement RX

Is “avoid high-impact exercise” bad advice for hip and knee osteoarthritis?

By Damian Cocciolone

If you’ve been told to stick to swimming and cycling because your osteoarthritic hip or knee “can’t handle” running, jumping, or court sports, a new study published in the British Journal of Sports Medicine is worth knowing about.

What the study looked at

Researchers used data from the GLA:D registry (Good Life with osteoArthritis in Denmark) — a large, structured exercise and education program for hip and knee OA — to track what happened to 17,661 people over 12 months. They split participants by how much high-impact physical activity they reported at baseline (things like running, jumping, or activities involving impact loading) and looked at who went on to have a total hip replacement (THR) or total knee replacement (TKR).

GLA:D pairs education on OA and safe movement with eight weeks of supervised, physio-led exercise, with outcomes tracked in a national registry — the same broad model we use one-on-one with our own OA patients in clinic.

The headline result: people with hip OA who did high-impact activity had 36–48% lower odds of ending up with a hip replacement within a year. For knee OA, high-impact activity wasn’t linked to a higher — or lower — chance of knee replacement. Either way, high-impact loading wasn’t the joint-wrecker it’s often assumed to be.

Why this matters

Clinical guidelines have long defaulted to recommending low-impact activity for OA — walking, swimming, cycling — largely out of caution rather than strong evidence that impact accelerates joint damage. That caution shapes what patients hear from GPs, family, and sometimes physios: protect the joint, avoid impact.

For a lot of people, that advice becomes permission to stop doing the sports and activities they actually enjoy, based on a fear of damage that isn’t well supported.

Where to be appropriately sceptical

This is registry data, not a randomised trial, and that matters for how much weight it should carry:

The people doing high-impact activity were probably already doing better. If your hip lets you run, your hip was likely in better shape to begin with. The study can’t fully separate “activity protected the joint” from “a healthier joint allowed the activity.” That’s the main reason this counts as encouraging evidence, not proof.
Twelve months is a short window. It tells us high-impact loading didn’t trigger a fast track to surgery — it doesn’t tell us what five or ten years of impact looks like for a degenerating joint.
Only around 5–6% of the cohort were doing high-impact activity. It’s a small, likely self-selected group, so don’t read this as “everyone with OA should take up running.”
The study couldn’t pin down why. The researchers tested whether pain, functional capacity, or fear of joint damage explained the link — mostly, they didn’t. We’re left with a solid association and an open question about mechanism.

What we take into clinic

This lines up with where sports and exercise medicine has been heading for a while: load management, not load avoidance. The joint isn’t fragile glass — it responds to graded, appropriate loading, and fear of movement is often a bigger problem than the movement itself.

In practice, that means:

We assess capacity, symptoms, and goals individually rather than applying a blanket “no impact” rule.
For hip OA especially, there’s now reasonable evidence to support continuing or returning to higher-impact activity where the joint tolerates it.
For knee OA, the message is more “impact won’t necessarily hurt you” than “impact will help you” — so activity choice still comes down to what the person can tolerate and wants to keep doing.
Fear of joint damage is worth addressing directly with patients — this study is a useful, specific example that impact isn’t automatically harmful.

If you’ve been sitting on the sideline of a sport or activity because of an OA diagnosis, it’s worth a conversation about what your joint can actually handle — rather than assuming the answer is “nothing high-impact.”

Reference: Liew BXW, Grønne DT, Roos EM, Skou ST. High-impact physical activity participation and 12-month risk of joint replacement: a longitudinal mediation analysis of 17,661 patients with knee or hip osteoarthritis. Br J Sports Med. 2026.

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