This randomized controlled trial compares criteria-based rehabilitation (CBR) with time-based rehabilitation (TBR) for football players aged 18-35 with ACL reconstruction, hamstring strain, or ankle sprain. Both groups receive a six-week supervised rehabilitation program; the progression rules differ between groups.
Injury Type: ACL reconstruction, hamstring strain, and ankle sprain.
Rehabilitation Phase: Phase 3 for ACL injuries, Phase 1&2 for hamstring strains and ankle sprains.
Football Activity: Active at club or regional football level
History of Major surgery in affected limb
Chronic neurological or musculoskeletal disorder
Non-football athletes
Parallel
Experimental: Criteria based
Other intervention* Weeks 1-2: Focus on pain control, ROM restoration, and isometric strengthening (low intensity, 3-4 sets of 10-15 reps). * Weeks 2-4: Closed-chain and eccentric strengthening (moderate intensity, 3 sets of 12-15 reps), balance training, and jogging once LSI ≥ 80%. * Weeks 4-6: Plyometrics, agility, sprinting, and football-specific drills (high intensity, 4-5 sets, 80-85% effort). Participants will only progress or return to play upon meeting the criteria: hop test LSI ≥ 90%, SEBT symmetry, improved ACLRSI,
Active comparator: Time based rehabilitation
Other interventionWeeks 1-2: Pain reduction and early strengthening (low intensity, 3 sets of 10-12 reps). * Weeks 2-4: General strengthening, proprioception, and jogging (moderate intensity, 3 sets of 12-15 reps). * Weeks 4-6: Plyometrics, agility, sprinting, and football-specific drills (high intensity, 70-85% effort) All participants will be cleared for return to play at the end of Week 6, regardless of whether they have achieved functional or psychological milestones, reflecting a traditional time-driven rehabilitation approach. This design reflects conventional rehabilitation models used in previous comparative studies, in which exercise progression and RTP clearance are determined by elapsed time rather than by functional recovery.
Hop battery test (single, triple, and crossover hop) including limb symmetry index (LSI)
A tool to assess lower-limb strength, power, symmetry and functional performance in athletes post-injury; demonstrates good test-retest reliability (ICC ≈ 0.85-0.97) and valid discriminatory ability, though its capacity to predict re-injury remains inconsistent
Star Excursion Balance Test (SEBT/Y-Balance)
Evaluates dynamic balance and postural control; high reliability (ICC 0.85-0.91) and validated in athletes
ACL-RSI (Return to Sport after Injury Scale)
Measures psychological readiness and fear of re-injury; strong internal consistency (α = 0.94) and test-retest reliability (ICC = 0.90)
Tampa Scale of Kinesiophobia (TSK)
Assesses fear of movement and re-injury; validated in musculoskeletal populations with good internal consistency (α = 0.810.87) and test-retest reliability (ICC = 0.84-0.90)
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