On this episode of the Women’s Football Hub Podcast, host Carolyn Kent is joined by Andrew Mitchell, sports physiotherapist with experience at RB Leipzig and co-author of the 2024 open-access paper A Return to Performance Pathway for Professional Soccer: A Criteria-Based Approach.
Together they unpack the entire journey an injured footballer takes — from the very first hours post-injury, through gym-based rehab, back onto the grass, and eventually into full match demands. The focus? Taking the guesswork out of rehab and giving practitioners confidence to progress players safely.
Diagnosis and the Power of Trust
The first 24–48 hours after injury are crucial. Andrew explains that uncertainty only fuels anxiety, so clarity around diagnosis and timelines is key.
Listening carefully to the player’s own words and tailoring the conversation to their personality type helps build trust. Some athletes want numbers, others prefer reassurance, and some need direct, no-nonsense clarity. However you frame it, the goal is the same: alignment from the very beginning.
Acute Management: More Than Just Pain
Carolyn reflects on her own early career habit of basing decisions solely on pain reports. Andrew points out the risks of that approach and introduces three supplementary criteria to guide progression:
- Clinical – swelling, stiffness, pain
- Physical – quality of movement, compensations
- Psychological – confidence, fear, readiness
Balancing these factors avoids both under- and over-loading, helping players move forward without unnecessary setbacks.
Gym Phases: Foundations Before Reconditioning
In Gym Phase 1, the emphasis is on simple but essential movement patterns: squats, lunges, bridges, heel raises, and single-leg balance. If a player can complete these cleanly, without adverse reactions, they are ready to progress.
Gym Phase 2 shifts towards reconditioning. The uninjured limb can act as a “role model,” giving the injured side a clear benchmark. Work in this phase is multi-dimensional — combining strength, plyometrics, and injury-specific drills, often in a single session.
Return to Running: Earning the Right
Every player wants to run again, but Andrew emphasises that it must be earned. Before stepping onto the grass, players complete Gym Phase 3 profiling. He prefers “profiling” to “testing” to reduce anxiety.
This ensures the player has the physical, clinical, and psychological capacity to tolerate running loads. Historical injuries (“outliers”) like stiff ankles, and current deficits such as lack of rotational control, must also be addressed before moving forward.
Back on the Grass
Returning to the pitch is a major psychological boost, but it must be carefully managed. Early sessions replicate drills rehearsed indoors, easing players into the new environment with confidence.
Loads are controlled — distances, intensities, and accelerations are planned. GPS is useful but not essential; a stopwatch, tape measure, or even subjective ratings can guide safe progression.
From Play to Performance
Andrew makes a clear distinction:
- Return to play = stepping onto the pitch, even for a few minutes.
- Return to performance = sustaining full training and match demands week after week.
Objective metrics (strength, hop performance, sprint capacity) give practitioners confidence in challenging conversations with managers and players. For Andrew, trust, data, and clear communication are the bedrock of these high-stakes decisions.
Psychological Readiness
Some players feel physically ready but hesitate mentally a common challenge in female athletes after ACL injuries. Andrew advises open dialogue to understand whether the issue is fear of reinjury, performance anxiety, or something deeper. Coaches, teammates, or sports psychologists may all have a role in supporting readiness.
Golden Rules for Practitioners
Andrew rounds off the podcast with four key lessons:
- Role clarity – Know exactly what part of the pathway is yours.
- Diagnosis and timelines – Agree these early with everyone involved.
- Phase readiness – Only progress if criteria are met.
- Prioritisation – Focus on what matters most each day, each session, each week.
Key Takeaways
- Take the uncertainty out of rehab with clear diagnosis and planning.
- Don’t rely on pain alone use clinical, physical, and psychological criteria.
- Build from foundational movement to reconditioning, then to running.
- Return to play is not the same as return to performance.
- Trust, communication, and reflection are essential at every stage.
This conversation is a must-listen for physiotherapists, coaches, and practitioners supporting injured players.
This blog was created with the assistance of ChatGPT and then checked and edited by the podcast host.
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#WomensFootball #ReturnToPerformance #SportsPhysio #InjuryRehab #FootballMedicine #ReturnToPlay #FemaleAthlete
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