The ankle feels better, so you return to tennis. Three weeks later, you roll it again. The hamstring settles down, you resume running, and that familiar pull returns.
Recurring sports injuries are frustrating, but previous injury itself is one of the clearest warning signs that another injury may occur.
A 2020 systematic review involving more than 71,000 athletes found that a history of hamstring injury increased the risk of another hamstring injury about 2.7 times, while a recent hamstring injury was associated with an even greater risk.[1] Research on other lower-extremity injuries has found similar patterns.[2]
Why?
Sometimes the pain improves before all of the abilities required for the sport have recovered.
Feeling Better Is Only Part of Recovery
Pain is important, but it does not provide a complete report on strength, endurance, mobility, balance, coordination, or the body’s tolerance for athletic activity.
Hamstring research provides a good example. A systematic review found that some flexibility and basic strength deficits improved during the weeks after a hamstring strain. However, deficits in certain measures of dynamic hamstring strength were still detectable after athletes had returned to play.[3] An athlete can therefore feel substantially better while some physical capacities are still catching up. That matters when the next game, run, match, or workout asks the recovering area to produce speed, power, balance, or repeated effort.
Rehabilitation Can Reduce the Risk of Another Injury
Ankle sprains provide particularly good evidence. A 2022 systematic review and meta-analysis included 14 randomized trials involving 2,182 people with acute lateral ankle sprains. Exercise-based rehabilitation reduced recurrent ankle sprains at 12 months compared with usual care. The pooled odds of another sprain were about 40% lower in the rehabilitation groups.[4] The researchers could not identify one ideal exercise program that worked best for everyone. The larger finding is useful: restoring function through exercise appears to improve the odds of staying recovered.
Depending on the injury, rehabilitation may address:
Strength
Joint mobility
Balance and coordination
Muscular endurance
Speed and power
Sport-specific movement
Confidence using the injured area
Gradual exposure to the demands of the activity
The exact priorities depend on the injury and the athlete.
Sometimes the Sport Has Simply Asked for Too Much, Too Soon
Recurrent pain is not always evidence of a hidden biomechanical flaw. Training load matters too. A systematic review of 57 studies found substantial evidence linking training load with musculoskeletal injury risk, although the relationship varied according to the sport, the type of workload measured, and the time period involved.[5]
For recreational athletes, the concept is fairly intuitive. A runner who normally covers 10 miles each week suddenly runs 25. A pickleball player accustomed to one session plays five times during vacation. A basketball player returns after several months away and immediately tries to perform at the old level. The athlete may have the skill and enthusiasm for the activity while lacking the current physical capacity for that volume. That is one reason a progressive return matters.
Look Beyond the Painful Spot
A physical therapy evaluation for a recurring sports injury involves more than examining where it hurts.
Depending on the sport and injury, a therapist may evaluate:
Strength around the injured joint or muscle
Side-to-side differences
Range of motion
Balance and neuromuscular control
Running, jumping, throwing, or other relevant movements
Recent changes in training frequency or intensity
Equipment or technique when appropriate
Whether the athlete has rebuilt enough capacity for the demands of the sport
These findings do not necessarily reveal one simple “cause.” Sports injuries are usually multifactorial.[1,5] They can, however, identify areas that still need work before the next return.
Don’t Make “The Pain Stopped” Your Only Return-to-Sport Test
Getting rid of pain is a welcome milestone. For someone planning to return to running, tennis, golf, basketball, pickleball, cycling, recreational leagues, or another demanding activity, the next question is whether the body is prepared for what that activity requires. If the same injury keeps returning, consider having it evaluated rather than repeating the same cycle of rest, temporary improvement, and immediate return to full activity. Physical therapy can help assess the injured area, identify remaining limitations that matter to the activity, and build a progressive plan for restoring strength, mobility, balance, endurance, or sport-specific capacity. The goal is more than getting back to the sport. It is improving the odds of staying there.
REFERENCES
Green B, Bourne MN, van Dyk N, Pizzari T. Recalibrating the risk of hamstring strain injury: a 2020 systematic review and meta-analysis of risk factors for index and recurrent hamstring strain injury in sport. Br J Sports Med. 2020;54(18):1081-1088. Available from: https://pubmed.ncbi.nlm.nih.gov/32299793/
Toohey LA, Drew MK, Cook JL, Finch CF, Gaida JE. Is subsequent lower limb injury associated with previous injury? A systematic review and meta-analysis. Br J Sports Med. 2017;51(23):1670-1678. Available from: https://pubmed.ncbi.nlm.nih.gov/28784622/
Maniar N, Shield AJ, Williams MD, Timmins RG, Opar DA. Hamstring strength and flexibility after hamstring strain injury: a systematic review and meta-analysis. Br J Sports Med. 2016;50(15):909-920. Available from: https://pubmed.ncbi.nlm.nih.gov/27075962/
Wagemans J, Bleakley C, Taeymans J, et al. Exercise-based rehabilitation reduces reinjury following acute lateral ankle sprain: a systematic review update with meta-analysis. PLoS One. 2022;17(2):e0262023. doi:10.1371/journal.pone.0262023. Available from: https://pubmed.ncbi.nlm.nih.gov/35134061/
Eckard TG, Padua DA, Hearn DW, Pexa BS, Frank BS. The relationship between training load and injury in athletes: a systematic review. Sports Med. 2018;48(8):1929-1961. doi:10.1007/s40279-018-0951-z. Available from: https://pubmed.ncbi.nlm.nih.gov/29943231/
