Objective
Every result is a number (Newtons, watts, centimeters, seconds) compared limb to limb with a Limb Symmetry Index (LSI).
For Physicians & Surgeons
Return to sport, backed by data.
Objective, criteria-based return-to-sport testing with 1080 Motion technology and Hawkin Dynamics force plates, with a clear, color-coded report back to you after every test.
After every testRed. Yellow. Green.
An at-a-glance status table, sent to you. See a sample
- 9 domainsOne standardized protocol
- Every repForce, speed and power, left vs. right
- R · Y · GStatus report to the referring physician
- Three clinicsLubbock, Colleyville, Irving
Our Approach
Time tells you how long. Testing tells you how ready.
Weeks since surgery is a minimum, not a green light. At iTOP, athletes advance when they meet objective criteria (strength, power, balance, jump and hop performance measured side to side), always inside the surgeon’s protocol.
Comprehensive
No single test clears an athlete. We look at the cluster: strength, power, balance, jump and landing, hop, movement quality and confidence.
Communicated
You get a short report with a red / yellow / green status table, a plain-language interpretation and a specific plan.
Criteria-gated progression: what we test, when
Protect
0–6 weeks
ROM, girth and effusion, quad activation, gait
Strength
6–12 weeks
Hand-held dynamometry; 1080 isokinetic knee extension / flexion
Load
3–6 months
1080 single-leg squat, Y-Balance, bilateral force-plate jumps
RTP Build
6–9 months
Single-leg jumps, drop jump, hop battery, 1080 lunges and hops
RTP Test
9–12 months
Full battery + IKDC and ACL-RSI; clearance recommendation
Timeframes shown are typical for ACL reconstruction. Progression is gated by criteria, not the calendar, and always follows the operating surgeon’s protocol.
The Test Battery
Nine domains. One standard.
| Domain | Tool | What it tells us | Green standard |
|---|---|---|---|
| Range of motion | Goniometer | Knee, ankle and hip motion, side to side | Full extension; symmetric |
| Girth | Gulick tape | Quad and calf atrophy; residual swelling | Symmetric; no effusion |
| Isometric strength | Hand-held dynamometer | Quad, hamstring and hip peak strength (lb and % body weight) | LSI ≥ 90% |
| Dynamic strength & power | 1080 Motion | Force (N) and power (W) at a controlled speed: knee ext/flex, single-leg squat and endurance, lunges, hops, hip; shoulder: scapula, rotator cuff, overhead press | LSI ≥ 90%; ≥ 95% pivot sports |
| Jump & reactive strength | Hawkin Dynamics force plates | CMJ height, modified RSI, braking RFD, single-leg jumps, drop jump | Asymmetry ≤ 10%; mRSI ≥ 0.55 |
| Dynamic balance | Y-Balance Test | Anterior, posteromedial and posterolateral reach; composite normalized to limb length | Composite ≥ 95%; anterior diff. ≤ 3 cm |
| Hop battery | Tape, timer | Single hop, triple hop, single-leg vertical, 40 cm lateral hop | LSI ≥ 90%; ≥ 95% pivot sports |
| Movement quality | Clinician-rated | Gait, overhead squat, single-leg squat, tuck-jump landing assessment | No compensations |
| Patient-reported | IKDC · ACL-RSI | Knee function, confidence and fear of re-injury | Trended every test |
Same protocol, every athlete, every time
Warm-up
Bike intervals (20 s on / 10 s off × 8) plus dynamic drills
Practice
Demonstration and practice trials: box jumps and broad jumps
Uninvolved first
Healthy limb tested first to set the reference value
Three trials
Per test, per side; LSI = involved ÷ uninvolved × 100
What Lands on Your Desk
Read it in thirty seconds.
After every test you receive a report of about three pages. Need the full data set? Ask. Every rep and trial is on file.
Met 90%+ Monitor 80 to 89% Needs work under 80%
- Status firstAn at-a-glance table with every domain marked Met (green), Monitor (yellow) or Needs Work (red).
- Numbers you can checkInvolved and uninvolved values with the LSI for each test, in Newtons, watts, pounds and centimeters.
- A short interpretationOne to three sentences per section. No jargon walls.
- A clear call and the planOverall status (Not Ready, Conditional or Cleared to Progress), the gates still open, visit frequency, focus areas and the retest date.
| Area | Bar | LSI | Status |
|---|---|---|---|
| Quad strength | 88% | Monitor | |
| Hamstring strength | 93% | Met | |
| Single-leg jump | 91% | Met | |
| Hop distance | 94% | Met |
LSI (limb symmetry index) = injured side ÷ other side × 100. Green is 90% or higher.
How We Score
Red. Yellow. Green. One glance.
LSI = involved ÷ uninvolved × 100. For timed tests, where faster is better, the formula is reversed (uninvolved ÷ involved).
| Measure | Red · Needs work | Yellow · Monitor | Green · Met |
|---|---|---|---|
| Strength LSI (HHD, 1080) | < 80% | 80–89.9% | ≥ 90% |
| Hop & single-leg vertical LSI | < 80% | 80–89.9% | ≥ 90% |
| Y-Balance composite | < 89% | 89–94.9% | ≥ 95% |
| Y-Balance anterior reach diff. | > 4 cm | 3–4 cm | ≤ 3 cm |
| Force-plate asymmetry | > 20% | 10.1–20% | ≤ 10% |
| CMJ modified RSI | < 0.40 | 0.40–0.54 | ≥ 0.55 |
| CMJ time to takeoff | > 0.80 s | 0.70–0.80 s | < 0.70 s |
| Pain / effusion after loading | Pain > 3/10 or effusion ↑ | Pain 1–3/10, mild | 0–1/10, no effusion |
Pain or effusion response is a hard stop. It is checked before any performance number is interpreted.
A higher bar for pivot & cutting sports
For basketball, soccer, volleyball and football, we look for ≥ 95% on hop and power tests before recommending unrestricted return.
Symmetry isn’t the whole story
The uninvolved leg is often deconditioned too, so LSI is read alongside absolute values, movement quality, symptoms and psychological readiness.
No single test clears an athlete. Our recommendation uses the full cluster (strength, power, balance, jump and landing, hop and sport exposure), and every clearance decision remains with the treating physician.
Sample Report · Illustrative
Watch the red turn green.
Illustrative example built from de-identified sample data in our Physician RTS Testing Guide. Not a real patient’s results.
| Area | Current result | Status |
|---|---|---|
| Quad strength (HHD) | 85% LSI (15% deficit) | Monitor |
| Hamstring strength (HHD) | 84% LSI | Monitor |
| Knee ext./flex. force (1080) | 88% LSI both directions | Monitor |
| Y-Balance composite | R 93% / L 103% | Monitor |
| Y-Balance anterior reach | 12 cm deficit on involved side | Needs work |
| Single-leg vertical | 81% LSI | Monitor |
| Single-leg / triple hop | 89% / 85% LSI | Monitor |
| Knee ROM | Full and symmetric | Met |
| Pain / effusion response | 0/10, no effusion after testing | Met |
Overall status: Conditional Continue strength and controlled plyometrics. Not yet cleared for cutting or full-court play; anterior reach and hop symmetry are the open gates. Retest in 12 weeks.
| Test | 3 months | 6 months | 9 months |
|---|---|---|---|
| Quad strength (hand-held dynamometer) | 75% | 85% | 103% |
| Hamstring strength (hand-held dynamometer) | 67% | 84% | 107% |
| Knee extension force (1080 Quantum) | 68% | 88% | 99% |
| Knee flexion force (1080 Quantum) | 78% | 88% | 93% |
| Y-Balance composite (involved limb, % of limb length) | 71% | 93% | 112% |
| Y-Balance anterior reach (deficit vs. uninvolved) | 33 cm | 12 cm | None |
| Single-leg vertical | 58% | 81% | 94% |
| Single-leg hop | 76% | 89% | 97% |
| Triple hop | 72% | 85% | 92% |
| Overall status | Not Ready | Conditional | Cleared to Progress |
- 3 months: Not Ready Global deficits. Continue strength phase; no impact progression.
- 6 months: Conditional Closing in, but anterior reach and hop symmetry gate running and cutting.
- 9 months: Cleared to Progress All domains green. Recommend sport-specific return, pending physician clearance.
Two de-identified case examples
Case example
Why two tools matter
A post-op knee patient showed a 27% quad deficit on isometric dynamometry, but 97–128% symmetry on 1080 dynamic force and power. The gap was peak isometric capacity, not dynamic output, so the plan prioritized loaded isometric quad work instead of more of everything.
Case example
What a hop test alone would have missed
A patient with excellent, symmetric Y-Balance scores still showed about 20% less single-leg jump height and 23% lower reactive strength on the involved leg, with braking RFD below target. Plyometric progression was held until those gaps closed.
1080 Motion Technology
Strength you can measure, rep by rep.
1080 systems use a computer-controlled motor instead of weight stacks. We set load and speed independently for the lifting and lowering phases, so testing is safe early in rehab, while the system records force, speed and power on every repetition, for each limb.
Lubbock clinic
1080 Quantum
Cable-based testing, training and rehab system. Isokinetic, isotonic, ballistic and eccentric-overload modes. Force, speed and power recorded 333 times per second.
Colleyville clinic
1080 Sprint 2
Robotic resisted and assisted sprint system. Measures speed, force and power. Used for speed development and late-stage performance training, and for our shoulder tests (scapular, rotator cuff, overhead press).
Two tests, two questions: strength vs. power
| Compare | Strength test | Power test |
|---|---|---|
| The question | How much force can the limb produce? | How fast can it produce it? |
| Mode | Isokinetic (speed-limited) | Ballistic (NFW) |
| Speed | 0.2–0.5 m/s concentric | Up to 8 m/s concentric |
| Load | Small external load; athlete self-limits | 5–10% of body weight |
| Output | Average force per rep (N) | Peak power per rep (W) |
Hawkin Dynamics Force Plates · Lubbock & Colleyville
How the jump happened, not just how far.
Hop distance can hide compensation: an athlete can reach the line by shifting load to the healthy leg. Dual force plates measure force under each foot through the whole jump, showing how the athlete loads, brakes and drives, and how much each leg contributes.
- Countermovement jump Bilateral output and strategy
- CMJ rebound Repeated, reactive jumping
- Single-leg CMJ Involved vs. uninvolved power
- Drop jump Landing and reactive stiffness
Force plate metrics in plain English
| Metric | In plain English | Green standard |
|---|---|---|
| Jump height | Overall output: how high the athlete gets | Age / sex / sport target |
| Time to takeoff | How quickly the athlete organizes and launches the jump | < 0.70 s |
| Modified RSI | Jump height ÷ time to takeoff (“explosiveness”) | ≥ 0.55 |
| Braking RFD | How fast the athlete absorbs load: the deceleration quality behind safe landing and cutting | ≥ 90% of baseline |
| Rebound / drop-jump RSI | Spring-like reactive strength off the ground | Rebound ≥ 0.70; drop jump > 2.0 |
| Left / right asymmetry | Side-to-side share of force in braking and propulsion | ≤ 10% (≤ 5% late stage) |
Cited Research
The research behind it.
Published return-to-sport research after ACL reconstruction, cited so you can read the original studies. These findings come from specific patient groups and are not iTOP results.
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Among 158 male professional athletes after ACL reconstruction, those who did not meet all six discharge criteria before returning had a four times greater risk of graft rupture.
Kyritsis P, Bahr R, Landreau P, Miladi R, Witvrouw E. Likelihood of ACL graft rupture: not meeting six clinical discharge criteria before return to sport is associated with a four times greater risk of rupture. Br J Sports Med. 2016;50(15):946–951. doi.org/10.1136/bjsports-2015-095908
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In 106 patients in pivoting sports, 5.6% of those who passed the return-to-sport criteria had a knee reinjury, compared with 38.2% of those who failed. The reinjury rate also fell for each month return was delayed, up to 9 months after surgery.
Grindem H, Snyder-Mackler L, Moksnes H, Engebretsen L, Risberg MA. Simple decision rules can reduce reinjury risk by 84% after ACL reconstruction: the Delaware-Oslo ACL cohort study. Br J Sports Med. 2016;50(13):804–808. doi.org/10.1136/bjsports-2016-096031
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Return to sport is best viewed as a continuum (return to participation, then return to sport, then return to performance), with graded, criterion-based progression and decisions shared by the athlete, clinicians, and coaches.
Ardern CL, Glasgow P, Schneiders A, et al. 2016 Consensus statement on return to sport from the First World Congress in Sports Physical Therapy, Bern. Br J Sports Med. 2016;50(14):853–864. doi.org/10.1136/bjsports-2016-096278
Refer an Athlete
Send them to us. We’ll send you the data.
Who to refer
- ACL reconstruction
- Meniscus repair / scope
- Patellar tendon and knee
- Ankle and hip injuries
- Shoulder: rotator cuff and scapular
- Healthy athletes: baseline testing
When
- At phase checkpoints (about 3, 6 and 9 months after ACLR)
- Before any clearance decision
- Whenever you want an objective read
Please send
- Referral / prescription
- Operative note (graft, concomitant procedures)
- Date of surgery
- Protocol restrictions
Lubbock
1080 Quantum · Hawkin Dynamics force plates
5614 126th St, Bldg C-3, Lubbock, TX 79424
Ph: 806-516-5722
Fax: 806-313-1946
Colleyville
1080 Sprint 2 · Hawkin Dynamics force plates
1821 John McCain Rd, Ste 103, Colleyville, TX 76034
Ph: 469-895-5198
Fax: 469-663-5520
Irving
Rehab and hands-on care
2642 N Belt Line Rd, Irving, TX 75062
Ph: 214-225-0291
Fax: 361-277-0056
Irving takes rehab referrals and offers the same hands-on care as our other clinics, plus clinical return-to-play testing, including testing-only sessions for athletes who rehab elsewhere. Force plate and 1080 testing is done at Lubbock or Colleyville.
Physician referrals
iTOP Recovery
appointments@itoprecovery.com
iTOP provides testing data and recommendations. Every clearance decision remains with the treating physician.