Sports Injury Recovery Testing for Optimal Performance

Rebuilding Performance After Trauma: What Objective Functional Gains Tell Us About Recovery

Abstract

Feeling better after an injury is important, but an athlete’s return to normal daily activities does not always mean athletic performance has fully recovered. Strength, endurance, balance, speed, mobility, power, and movement control can remain limited even when pain is minimal or gone. Serial functional testing provides clinicians and athletes objective information about how those abilities change during rehabilitation. These measurements can help guide treatment, exercise progression, and return-to-sport decisions. However, functional improvement does not independently prove what originally caused an injury. Determining causation requires a broader clinical analysis that considers trauma history, symptoms, prior health, examination findings, diagnostic studies, and the timing of the condition.

When “I Don’t Hurt Anymore” Is Only Part of the Story

Imagine a recreational athlete who was injured in a motor vehicle collision several months ago.

Before the crash, he played recreational basketball twice a week, lifted weights, and occasionally joined weekend running events. Early in his recovery, ordinary activities were difficult. His back was painful, his hip felt stiff, and prolonged walking caused fatigue.

After several weeks of rehabilitation, things changed.

He can:

• Walk through the grocery store without pain.
• Sit through a workday.
• Drive comfortably.
• Sleep better.
• Climb stairs without thinking about every step.
• Perform normal household activities.

From his perspective, he feels almost recovered.

Then he attempts a more demanding performance assessment.

His single-leg balance is worse on one side. His injured-side strength drops as repetitions accumulate. He cannot accelerate or change direction as smoothly as before. During repeated squats, his movement becomes less controlled. His cardiovascular endurance is below his previous level.

He asks a reasonable question:

“If I don’t have much pain anymore, why am I still having trouble performing?”

The answer illustrates an important principle of sports rehabilitation: absence of pain and restoration of performance are not necessarily the same thing.

Modern return-to-sport frameworks increasingly view recovery as a progression from basic participation to sport and finally to previous performance. Objective testing can help identify where an athlete currently sits on that continuum (Ardern et al., 2016; Meredith et al., 2020).

Recovery Has More Than One Dimension

Pain is valuable clinical information, but it is only one part of recovery.

An athlete may have mild discomfort while still demonstrating deficits in:

• Strength
• Muscular endurance
• Joint range of motion
• Power
• Balance
• Coordination
• Agility
• Reaction ability
• Movement quality
• Cardiovascular endurance
• Confidence during high-demand movement

That is why a rehabilitation program should not necessarily end simply because ordinary daily activities have become comfortable.

A person might tolerate walking perfectly well yet struggle with sprinting. Someone may climb stairs without difficulty but lose knee control during repeated jumping. An athlete may have full shoulder motion during a routine examination yet lack the endurance necessary for repeated throwing.

The physical demands are different.

For athletes, the meaningful question eventually changes from “Can you function?” to “Can you perform the movements your activity requires?”

Research and sports-medicine consensus statements support combining symptoms, physical examination findings, objective functional testing, sport-specific demands, psychological readiness, and clinical judgment when deciding how rehabilitation should progress (Ardern et al., 2016; Meredith et al., 2020).

What Is Serial Functional Testing?

A single functional assessment provides a snapshot.

Serial functional testing creates a timeline.

Clinicians repeat the same or comparable measurements at appropriate points during rehabilitation. This lets the clinician see whether performance is improving, staying unchanged, or declining.

Depending on the injury and the athlete’s goals, testing may examine:

Range of Motion

Clinicians may measure how well an injured joint or body region moves and compare those findings with earlier examinations or the opposite side when appropriate.

Strength

Clinicians can evaluate strength through resisted movement, handheld dynamometry, exercise performance, or other validated techniques.

Rather than simply saying an athlete “seems stronger,” numerical measurements can sometimes provide a clearer way to document progress.

Muscular Endurance

Maximum strength is not everything.

A person may perform one repetition successfully but lose form after repeated loading. Endurance testing may reveal deficits that are invisible during simpler daily activities.

Balance and Sensorimotor Control

After some lower-extremity injuries, athletes can develop difficulty maintaining stability during single-leg activity or rapidly correcting their position.

This matters in sports involving cutting, landing, jumping, or unpredictable movement.

Power

Power combines strength with speed.

Jumping, sprinting, throwing, and explosive changes in direction require more than the ability to generate force slowly.

Agility and Sport-Specific Movement

Later rehabilitation may introduce increasingly demanding tasks, such as:

• Cutting
• Hopping
• Jumping
• Accelerating
• Decelerating
• Changing direction
• Throwing
• Repeated lifting
• Running under fatigue
• Sport-specific drills

Research on return-to-sport testing emphasizes that athletes often need assessment under conditions that resemble the demands they will actually face rather than relying entirely on simple clinic-based exercises (Ardern et al., 2016).

Dr. Jimenez discusses a similar assessment-and-retesting approach in Athletes: Preventing Future Injuries With Movement Analysis.

Why Repeated Testing Can Be More Useful Than One Test

Suppose our recreational athlete initially demonstrates only 60% of his expected single-leg endurance.

Six weeks later, he reaches 75%.

Later, he reaches 88%.

That progression tells the clinical team something important.

The number does not automatically determine whether he is ready to compete, but it demonstrates measurable improvement.

Serial measurements can help answer practical rehabilitation questions:

• Is strength returning?
• Is endurance improving?
• Has movement symmetry changed?
• Does performance deteriorate with fatigue?
• Is the athlete tolerating progressive loading?
• Should the rehabilitation program become more challenging?
• Has progress stalled?
• Is another clinical evaluation necessary?

This makes objective data especially useful for guiding care over time.

Performance testing has long been used to quantify physical ability during rehabilitation, and current return-to-sport recommendations increasingly favor measurable, criteria-based progression over relying solely on the passage of time (Cates & Cavanaugh, 2009; Meredith et al., 2020).

Functional Gains Can Support a Recovery Narrative

Consider what happens over several examinations.

At the first assessment, our athlete demonstrates:

• Reduced hip mobility
• Poor single-leg stability
• Weakness during resisted movement
• Early fatigue
• Difficulty changing direction

Following rehabilitation, later testing demonstrates:

• Greater mobility
• Improved stability
• Increased strength
• More repetitions before fatigue
• Better control during sport-specific movements

That pattern provides useful information.

It suggests that measurable physical limitations were present and that they changed during rehabilitation.

It may also help clinicians explain why they progressed, modified, continued, or eventually reduced treatment.

But an important medical-legal distinction remains.

Functional Improvement Does Not Prove What Caused the Original Injury

Imagine that an athlete’s leg strength improves by 30% during rehabilitation.

What does that tell us?

It tells us that strength changed.

It may help demonstrate that an impairment existed and that the patient’s physical capacity improved.

But the strength test itself cannot tell us why the weakness developed in the first place.

That distinction is essential.

A functional test performed weeks after an accident cannot independently determine whether weakness resulted from:

• The recent accident
• An older injury
• A preexisting condition
• Deconditioning
• A neurological problem
• Another medical condition
• Several contributing factors

Functional testing answers questions about capacity and progress.

Medical causation asks a different question:

What most reasonably explains how the injury occurred?

Those questions overlap, but they are not interchangeable.

Establishing Causation Requires the Whole Clinical Picture

When an injury follows trauma, causation is evaluated by examining multiple pieces of evidence together.

A clinician may consider:

The Mechanism of Injury

What physically happened?

Was there rapid acceleration or deceleration? A direct blow? Rotation? Compression? A fall? Sudden loading?

The proposed mechanism should make anatomical and biomechanical sense for the injury being considered.

Timing

When did symptoms begin?

A close temporal relationship between trauma and the development of compatible symptoms can be relevant, but timing alone does not establish causation.

Prior Medical History

Was the athlete experiencing similar symptoms before the event?

A prior condition does not automatically rule out a new injury or aggravation, but the history must be considered.

Physical Examination

Findings such as reduced motion, weakness, neurological changes, tenderness, swelling, instability, or other objective abnormalities can contribute to the clinical analysis.

Diagnostic Testing

When clinically appropriate, imaging or other diagnostic studies may help define structural or neurological findings.

Functional Findings

Movement, strength, balance, and endurance testing can document how the injury affects function.

Serial Reassessment

Changes over time can demonstrate whether the clinical course is consistent with recovery, persistent impairment, or an unexpected pattern requiring reevaluation.

None of these elements should be treated as a magic answer on its own.

Causation is a clinical conclusion developed from the total evidence.

Functional performance testing contributes important information to that analysis, but it should not be presented as proof that an accident caused an injury simply because the patient’s test scores later improved.

Pain Relief Can Arrive Before Performance Recovery

One reason functional testing matters is that symptoms can improve faster than athletic capacity.

Daily activities usually demand much less from the body than sports.

Walking across an office is not the same as sprinting down a basketball court.

Standing from a chair is not equivalent to repeated barbell squats.

Reaching into a cabinet is not equivalent to throwing a baseball dozens of times.

Walking upstairs is not equivalent to repeated jumping and landing under fatigue.

This explains why a recreational athlete may sincerely report:

“I feel fine.”

Yet sport-specific testing can reveal that the nervous system, muscles, joints, and movement patterns are not fully prepared for competition.

For return-to-sport decisions after ankle injuries, for example, expert consensus recommends considering pain, joint impairments, strength, endurance, power, athlete confidence, sensorimotor control, balance, hopping, jumping, agility, sport-specific drills, and the ability to complete training (Smith et al., 2021).

That illustrates why recovery is broader than a pain score.

Testing Also Has Limitations

Objective testing is valuable, but it is not perfect.

Tests Do Not Completely Reproduce Competition

A clinic cannot recreate every unpredictable feature of a basketball game, wrestling match, soccer field, running course, or weightlifting competition.

Symmetry Is Not Always the Same as Normal

Comparing one side with the other can be helpful, but the opposite side may also be weak or deconditioned.

One Good Test Does Not Guarantee Readiness

An athlete can perform well on a strength test yet struggle with endurance, balance, agility, confidence, or sport-specific loading.

Fatigue Changes Performance

Testing performed while fresh may look different from movement after repeated activity.

Different Sports Require Different Standards

The demands placed on a runner are not the same as those placed on a wrestler, tennis player, football lineman, gymnast, or overhead athlete.

That is why clinicians should use functional data as part of a broader decision-making process rather than relying on a single test or percentage.

A 2025 review of return-to-sport testing after ACL reconstruction similarly identified multiple useful categories, including strength, hopping and jumping ability, functional performance, and patient-reported readiness, while recognizing that test selection depends on the clinical situation and available resources (Neves et al., 2025).

The PUSH as Rx Approach: Measure, Rebuild, Reassess

The philosophy behind PUSH as Rx is especially relevant here.

Athletic rehabilitation should not simply chase symptom disappearance. The larger objective is rebuilding the physical abilities required for the individual’s life and sport.

That may involve progression through:

1. Pain control and protection of injured tissues
2. Restoration of mobility
3. Basic movement retraining
4. Strength development
5. Muscular endurance
6. Balance and neuromuscular control
7. Power development
8. Agility and change-of-direction training
9. Sport-specific loading
10. Return-to-performance assessment

Dr. Jimenez’s PUSH as Rx resources focus on individualized strength, conditioning, mobility, agility, and performance development.

Athletes recovering from injury may also benefit from reviewing Sports Injury Rehabilitation in El Paso and Integrated Chiropractic and NP Care for Sports Injuries.

The goal is not to rush an athlete through arbitrary milestones. It is to identify meaningful deficits, progressively restore capacity, and reassess the athlete as physical demands increase.

Integrative Care Can Connect Structure With Performance

An athlete’s performance limitation does not always originate from one isolated muscle.

Movement involves coordinating joints, muscles, connective tissue, balance systems, and the nervous system.

For appropriate patients, an integrated rehabilitation plan may therefore include:

• Chiropractic assessment and treatment
• Joint mobility care
• Soft-tissue treatment
• Corrective exercise
• Progressive strengthening
• Balance training
• Neuromuscular retraining
• Mobility and flexibility work
• Sport-specific conditioning
• Medical evaluation when indicated
• Diagnostic imaging or laboratory testing when clinically appropriate

The purpose is not simply to make the athlete feel different on the treatment table.

The more meaningful question is:

Does the athlete move, function, and perform better afterward?

That is where objective reassessment becomes valuable.

For athletes with more complicated injuries, Dr. Jimenez also discusses rebuilding strength, mobility, and sport-specific function before competition in Regenerative Sports Care for El Paso Athletes.

What Makes Injury Medical Chiropractic and Functional Medicine Clinic Different?

Injury Medical Chiropractic and Functional Medicine Clinic uses a multidisciplinary model that brings chiropractic rehabilitation together with medical evaluation and advanced clinical oversight. Dr. Maria Guadalupe Cardenas, MD, a board-certified internal medicine physician, serves as Medical Director, Clinical Director, and Collaborative Physician, and the clinical team also includes nurse-practitioner care focused on evaluating and managing soft-tissue and musculoskeletal injuries. Dr. Alex Jimenez, DC, APRN, FNP-BC, bridges chiropractic physical medicine with advanced-practice medical assessment, helping coordinate structural rehabilitation with diagnostic and functional care.

This model lets patients move between musculoskeletal assessment, medical evaluation, rehabilitation, functional testing, and advanced treatment options when clinically appropriate, rather than treating each part of recovery in isolation. The clinic describes this integrated combination of services as unique in the El Paso area. Patients can learn more about its multidisciplinary structure through Why Choose Dr. Jimenez and the Clinical Team.

The goal remains patient-centered: determine what is clinically appropriate, explain available choices, monitor the response, and coordinate care with the patient’s existing physicians and healthcare professionals when necessary.

Objective Progress Supports Better Decisions

Return to sport should not be reduced to a calendar date.

Neither should recovery be defined only by whether an athlete hurts.

Our recreational athlete may be perfectly capable of going to work, shopping, driving, and performing household activities while still lacking the power, endurance, balance, or movement control needed for competitive activity.

Serial functional testing helps expose that difference.

The data can help clinicians:

• Establish functional baselines.
• Identify remaining limitations.
• Monitor rehabilitation progress.
• Set measurable goals.
• Adjust exercise intensity.
• Determine when higher-level testing is appropriate.
• Support safer return-to-activity decisions.
• Document when treatment goals have been reached.

At the same time, responsible interpretation matters.

• Improved strength does not, on its own, establish that an accident caused the original weakness.
• Improved balance does not independently establish the source of an injury.
• Improved endurance does not independently identify the mechanism of trauma.

Those measurements document what the body can do and how that ability changes.

Causation requires additional clinical work to connect the history, mechanism, timing, examination, diagnostics, prior health, and subsequent course.

The Goal Is Return to Performance, Not Just Return to Activity

For many injured athletes, the most exciting milestone is not the day their pain reaches zero.

It is the day they trust their body again.

It is completing the first full practice.

Making the first hard cut.

Running without guarding.

Lifting confidently.

Finishing a workout without an unexpected drop in strength or endurance.

That is why objective functional assessment can be so useful.

It turns recovery from a vague feeling into something you can observe, measure, challenge, and progressively rebuild.

Pain relief matters.

Daily function matters.

Strength matters.

Endurance matters.

Movement quality matters.

And for an athlete, performance matters.

The best rehabilitation decisions consider all of them while recognizing exactly what each measurement can—and cannot—tell us.

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References

Ardern, C. L., Glasgow, P., Schneiders, A., Witvrouw, E., Clarsen, B., Cools, A., Gojanovic, B., Griffin, S., Khan, K. M., Moksnes, H., Mutch, S. A., Phillips, N., Reurink, G., Sadler, R., Silbernagel, K. G., Thorborg, K., Wangensteen, A., Wilk, K. E., & Bizzini, M. (2016). 2016 consensus statement on return to sport from the First World Congress in Sports Physical Therapy, Bern. British Journal of Sports Medicine, 50(14), 853–864.

Cates, W., & Cavanaugh, J. (2009). Advances in rehabilitation and performance testing. Clinics in Sports Medicine, 28(1), 63–76.

Meredith, S. J., Rauer, T., Chmielewski, T. L., Fink, C., Diermeier, T., Rothrauff, B. B., Svantesson, E., Hamrin Senorski, E., Hewett, T. E., Sherman, S. L., Lesniak, B. P., & Musahl, V. (2020). Return to sport after anterior cruciate ligament injury: Panther Symposium ACL Injury Return to Sport Consensus Group. Knee Surgery, Sports Traumatology, Arthroscopy, 28, 2403–2414.

Neves, P. P., et al. (2025). A guideline for validated return-to-sport testing in everyday clinical practice: A focused review on the validity, reliability, and feasibility of tests estimating the risk of reinjury after ACL reconstruction. Orthopaedic Journal of Sports Medicine.

Smith, M. D., Vicenzino, B., Bahr, R., Bandholm, T., Cooke, R., Mendonça, L. D. M., Fourchet, F., Glasgow, P., Gribble, P. A., Herrington, L., Hiller, C. E., Hoch, M. C., McKeon, P. O., Owoeye, O. B. A., Reid, D., Tassignon, B., Terada, M., Thorborg, K., Verhagen, E., … Delahunt, E. (2021). Return to sport decisions after an acute lateral ankle sprain injury: Introducing the PAASS framework—An international multidisciplinary consensus. British Journal of Sports Medicine, 55(22), 1270–1276.

The information provided is intended for educational purposes and does not replace an individualized examination, diagnosis, medical opinion, or return-to-sport evaluation by a qualified healthcare professional.