To critically evaluate current literature on return-to-sport (RTS) criteria following Achilles tendon and hamstring injuries, a focused review was conducted to assess the strength of evidence supporting existing protocols and identify areas of inconsistency and clinical opportunity within Physical Medicine & Rehabilitation (PM&R). A targeted literature search was performed using PubMed, Google Scholar, and PubMed Central databases, including peer-reviewed studies published between 2016 and 2025. Ten articles comprising systematic reviews, consensus guidelines, and qualitative and cohort studies were analyzed to identify commonly reported RTS criteria and evaluate their evidentiary support in lower-extremity rehabilitation. Across the reviewed literature, RTS decision-making was predominantly time-based rather than performance-based. For hamstring injuries, commonly cited criteria included pain-free range of motion, ≥90% limb strength symmetry, and tolerance of sport-specific sprinting; however, validation of these benchmarks against reinjury risk remains limited. RTS protocols for Achilles tendon injuries emphasized single-leg heel-rise endurance, plantarflexion strength symmetry, and reactive strength measures, yet demonstrated substantial variability in threshold values and limited outcome validation. Psychological readiness was inconsistently incorporated and rarely included as a formal component of RTS clearance across both injury types. Emerging evidence supports the use of objective, criteria-based benchmarks—such as ≥90% limb strength symmetry, <10% eccentric strength asymmetry, single-leg heel-rise endurance exceeding 90%, and reactive strength index values approaching 0.8—as potential indicators of readiness for RTS following Achilles tendon and hamstring injuries. Despite these advances, time-based clearance protocols remain predominant. Development of standardized, evidence-driven RTS frameworks integrating objective performance metrics and psychological readiness may improve rehabilitation precision, enhance athlete safety, and promote reproducible outcomes in lower-extremity sports medicine practice.

Mehr Boparai is a medical student originally from Hanford, California. She completed her undergraduate education at the University of California, Davis, where she earned a Bachelor of Science in Human Development. She is currently a medical student at the College of Osteopathic Medicine of the Pacific– Northwest (COMP-NW) at Western University of Health Sciences. Mehr is an active member of the AOCPMR Medical Student Council Mentorship Committee and is interested in pursuing a career in Physical Medicine & Rehabilitation. In her free time, she enjoys playing volleyball and experimenting with new matcha recipes.