RTS Reactive-Readiness Checklist

Physical tests clear the body. This checklist adds the cognitive-motor criteria that hop tests miss.
Chmielewski et al. (IJSPT 2024) found that ACL patients gained less on QuickBoard reaction tests than on hop tests after return-to-sport training. It was independent research from TRIA Orthopedic Center. Physical readiness and cognitive-motor readiness are two different things. This checklist covers both.

Part 1: Physical Readiness

Check these off before moving to Part 2.

LSI at or above 90% on single-leg hop test series (single, triple, crossover, 6-meter timed)
Quadriceps and hamstring strength symmetry at or above 90% vs. contralateral limb
Full, pain-free ROM vs. contralateral side
No effusion
Functional movement screens completed per protocol
Physician or supervising clinician clearance

If any box in Part 1 is unchecked, address physical deficits before proceeding to Part 2.

Part 2: Cognitive-Motor Readiness

What hop tests do not measure: reaction time, decision speed, and cognitive-motor symmetry.

2a. Baseline established

Pre-injury or population-normative cognitive-motor baseline on file
Bilateral reaction time and accuracy recorded at start of rehab episode

2b. Reaction time symmetry

Involved limb reaction time within defined range of uninvolved limb
No gross asymmetry in left-vs.-right contact time or accuracy data

2c. Performance under cognitive load

Go/No-Go or Stroop-based protocol completed at or above pre-injury or normative accuracy
Performance stable (not declining) across repeated sessions in the 2 weeks before RTS
Correct movement demonstrated under dual-task conditions (cognitive demand plus motor output simultaneously)

2d. Assessment documentation

Agility Rating score on file for the discharge record
PDF report generated and attached to the patient note

If any box in Part 2 is unchecked, the athlete has physical clearance without cognitive-motor clearance. The research supports holding RTS until both sections are cleared.

Why This Gap Matters

The finding. ACL patients gained more on hop tests than on reaction tests after return-to-sport training (Chmielewski et al., IJSPT 2024). Hop results and reaction results did not move together.

The recommendation. Leading clinical guidance on neurocognitive and neuromuscular rehabilitation recommends incorporating neurocognitive training into ACL rehabilitation. This checklist reflects that guidance in clinical practice.

The practical problem. Most clinics have no objective way to assess and document cognitive-motor readiness at RTS. The criteria in Part 2 require a system that measures bilateral reaction time, runs cognitive load protocols, and generates documentation.

How to Use This Checklist

For new ACL patients: Establish the Part 2 baseline at the start of the rehab episode, not at discharge. That gives you a trend line, not just a snapshot.
For late-stage rehab (months 4+): Run Part 2 at each RTS evaluation alongside your standard hop test battery. Both sections must clear before RTS.
For the discharge note: Attach the Agility Rating Report PDF. It includes CPT 97750 billing documentation pre-filled.
For multi-clinician practices: Use this as a shared standard so every clinician clears the same criteria before RTS, regardless of who was primary.

QuickBoard automates the cognitive-motor criteria in Part 2. The sensor board and iPad and iPhone app run reaction time protocols, capture bilateral symmetry data to the millisecond, and auto-generate PDF reports with CPT 97750 billing documentation after every session. thequickboard.com/demo → See it in 15 minutes

Clinicians at Johns Hopkins,
Baylor Scott and White,
Select Medical, and Banner Health.
NBA, NFL, and MLB teams.

Recommended technology for
neurocognitive and neuromuscular
rehabilitation.