A one-page guide for deciding whether an MSK patient is ready to progress, should hold, or needs to regress. General guidance for clinicians; adapt to the condition, the patient and the evidence for that pathway.
Before progressing to the next phase, check:
1
Pain response: pain during loading stays within the agreed level (for example, at or below 5/10 when using a pain-monitoring approach), settles by the next morning, and isn't trending up week to week.
2
Swelling / irritability: no increase in swelling or effusion after the previous session's load.
3
Range of motion: the target range for the current phase has been reached.
4
Strength: the strength target for the phase has been met, ideally measured (for example, with a dynamometer or limb symmetry index) rather than estimated.
5
Load tolerance: the current phase's load has been tolerated across several sessions without a flare.
6
Movement quality: the phase's functional tests are completed with acceptable control.
7
Confidence: the patient feels ready. Fear of re-injury is screened for, not assumed away.
8
Red flags screened: none present, and any new symptoms have been reviewed.
9
Patient goals: the next phase moves towards what matters to them.
Hold when the criteria aren't met yet but symptoms are stable. Regress when pain or swelling increases after loading, or function drops. Refer or review urgently when red flags appear (for example, unexplained night pain, systemic symptoms, neurological changes, or signs of infection or DVT after surgery).
Why criteria?
In a well-known cohort study after ACL reconstruction, athletes who met return-to-sport criteria had substantially fewer re-injuries than those who returned without meeting them (Grindem et al., 2016, British Journal of Sports Medicine). Time since injury tells you when to check; criteria tell you whether to progress.
Myonect · Built by a physio in regional Queensland · myonect.com.au · This is general professional guidance, not individual medical advice.