SCS Rehabilitation & Return to Activity 3 — Questions and Answers
Question 1: According to the Sport Concussion Assessment Tool (SCAT), what is the FIRST step in the graduated return-to-sport (GRTS) protocol after a concussion?
- Light aerobic exercise
- Symptom-limited daily activity (Correct answer)
- Sport-specific exercise
- Full-contact practice
Correct answer: Symptom-limited daily activity
Symptom-limited daily activity (complete physical and cognitive rest until symptom-free) is the first stage before any aerobic exercise is introduced in the GRTS protocol.
Question 2: Blood flow restriction (BFR) training is most appropriate during which phase of ACL reconstruction rehabilitation?
- Preoperative strength preservation and early postoperative quadriceps activation (Correct answer)
- Late-stage plyometric training
- Return to full practice
- Post-clearance maintenance
Correct answer: Preoperative strength preservation and early postoperative quadriceps activation
BFR training allows muscle hypertrophy and strength gains at low loads (20–30% 1RM), making it ideal for early postoperative and preoperative phases when heavy loading is contraindicated.
Question 3: A football lineman has completed all functional criteria for return to sport but scores below the recommended cutoff on the ACL Return to Sport after Injury (ACL-RSI) scale. What should the clinician do?
- Clear him for full return since physical criteria are met
- Delay return and address psychological readiness through education and mental skills training (Correct answer)
- Refer immediately to psychiatry
- Repeat all functional testing in 2 weeks
Correct answer: Delay return and address psychological readiness through education and mental skills training
Low ACL-RSI scores are independently associated with re-injury and lower sport performance; psychological readiness must be addressed before return to full contact.
Question 4: Which plyometric progression principle is MOST important when designing a return-to-sport jumping program after patellar tendinopathy?
- Begin with bilateral before advancing to unilateral tasks (Correct answer)
- Start with maximal-effort jumps to identify pain threshold
- Prioritize speed over mechanics initially
- Use reactive drills before bilateral squat jumps
Correct answer: Begin with bilateral before advancing to unilateral tasks
Bilateral loading distributes forces across both limbs, reducing patellar tendon load, and should precede unilateral tasks in plyometric progression for tendinopathy rehabilitation.
Question 5: A swimmer recovering from shoulder labral repair is 12 weeks post-op. Her GIRD (glenohumeral internal rotation deficit) measures 20° compared to the contralateral side. What is the priority intervention?
- Strengthen the rotator cuff in external rotation
- Posterior capsule stretching (e.g., sleeper stretch) (Correct answer)
- Kinesio taping of the posterior shoulder
- Progress to freestyle swimming immediately
Correct answer: Posterior capsule stretching (e.g., sleeper stretch)
A GIRD of ≥15–20° is clinically significant and is addressed with posterior capsule stretching (sleeper and cross-body stretch) to restore full internal rotation.
Question 6: In a criteria-based return-to-run program after a tibial stress fracture, which criterion must be satisfied FIRST?
- Completion of 30 minutes of pool running
- Pain-free walking at normal pace for 30 minutes (Correct answer)
- Symmetrical single-leg hop distance
- MRI evidence of complete cortical healing
Correct answer: Pain-free walking at normal pace for 30 minutes
Pain-free ambulation at full weight-bearing is the foundational criterion that must be established before any running or impact activity is introduced.
Question 7: Which quadriceps-to-hamstring (Q:H) strength ratio at 60°/s on isokinetic testing is considered the minimum conventional ratio before return to running after knee injury?
- 0.45–0.55
- 0.60–0.80 (Correct answer)
- 0.90–1.00
- 1.10–1.20
Correct answer: 0.60–0.80
A conventional Q:H ratio of 0.60–0.80 at 60°/s is the accepted normative range, with values below this indicating hamstring relative weakness and elevated injury risk.
SCS Rehabilitation & Return to Activity 3
According to the Sport Concussion Assessment Tool (SCAT), what is the FIRST step in the graduated return-to-sport (GRTS) protocol after a concussion?