A wrestler came to me complaining of neck pain radiating down his arm to his fingers. Everyone had been treating the neck. When I took a proper history and assessed the full picture, the neck pain was not the source. He had a chronic rotator cuff injury with significant shoulder weakness. Because the shoulder muscles were weak, he was compensating by overusing his neck muscles and accessory muscles to perform the same movements.

Once we shifted focus to strengthening the shoulder, the load on the neck reduced automatically. The neck pain, which had not responded to weeks of neck treatment, resolved once the shoulder was working properly. The pain was in the neck. The problem was in the shoulder.

This is what I learned working with wrestlers from CRPF teams across India and through my connection with Chhatrasal Stadium. The Chhatrasal community did not come to me through marketing. One wrestler had a complete ACL tear, I rehabilitated him, and he went back to his teammates and told them. They came despite having in-house physiotherapists. That referral came from results, not from a brochure.

Greco-Roman and freestyle wrestling place completely different demands on the body. Greco-Roman is upper-body dominant, loading the shoulders, neck, and thoracic spine. Freestyle involves full-body explosive movements with high demands on the hips, knees, and lower back. I build protocols specific to the discipline, the position, and the phase of the competitive season. Most physiotherapists treat a wrestler the same way they treat anyone else. I do not.

This has happened more than once. A wrestler recovers from an ACL injury. Physically, he is doing everything he was doing before. The surgeon is confident. Everyone says he is ready. I am not ready to clear him.

Wrestlers often have exceptional baseline muscle strength, which means they recover faster than most patients. They reach physical benchmarks earlier. But return to competition is not only about physical fitness. Mental readiness is equally important. When I see fear and apprehension in a patient’s eyes, when he is hesitant to load the knee fully or flinches during sport-specific drills, that tells me he is not ready regardless of what the strength measurements say.

If an athlete returns to sport with fear and apprehension, the chances of reinjury are significantly higher. The body compensates for the fear. The mechanics change. The risk multiplies.

I asked for four to six more weeks. We started with normal practice, then lighter weights, then gradually increased load and frequency. Two sessions per week before returning to four. We let the mental readiness come in alongside the physical. When he finally returned to competition, he did not reinjure. That is not luck. That is not cutting corners on the process.

The most common mistake I see in cricket rehabilitation in Delhi is this: clinics wait for the pain to go and then send the player back. Pain free becomes the exit criterion. It should not be.

What happens inside a rehabilitation centre is very different from what happens on a cricket ground. The environment is different, the pitch is different, the physical and mental demands are completely different. A person can be pain free but completely unfit to play cricket. The sport is far more demanding than having no pain.

The rehabilitation has to replicate what the athlete will actually do on the ground. Not bed exercises. Not machine exercises. Not just pain management. Sport-specific exercises that mirror the exact demands of batting, bowling, or fielding. A fast bowler needs to train the hyperextension load pattern that caused the stress fracture in the first place, at a controlled progressive intensity, before returning to bowling. Without that, the injury comes back.

Through my work at Sporting Ethos as Centre Head across 15 disciplines, cricket was one of the primary sports. I learned that position-specific rehabilitation is non-negotiable. A fast bowler’s lower back and a batsman’s shoulder are completely different clinical problems despite both playing the same sport.

Even if someone else has already diagnosed a patient, I do my own assessment. Always. This is not about distrust. It is because shoulder pain can come from many different sources, and the symptoms often look the same from the outside. Impingement, a rotator cuff tear, a simple strain, or frozen shoulder — all can present with similar complaints. But they are not the same condition and they do not respond to the same treatment.

Differential diagnosis is what separates a correct treatment plan from one that produces no result. There are specific clinical tests for each condition. The symptoms might overlap, but there are specific signs that differentiate one from another. I run those tests systematically before I plan anything.

Frozen shoulder has classical signs: night pain that disrupts sleep, loss of shoulder abduction, loss of external rotation. And it progresses through phases — freezing, frozen, and thawing — each of which requires a different rehabilitation approach. The treatment that works in the freezing phase is different from what works in the thawing phase. Treating all phases the same way is why so many frozen shoulder cases drag on for years without resolution.

I correlate the patient’s symptoms with which phase they are in, and build the rehabilitation plan around that phase. Not around the diagnosis label they arrived with.

A patient came to me with chronic lower back pain. The cause was not in the lower back at all. It was coming from the cervical spine and the mid-thoracic region.

The spine works as one connected chain. If one segment is not working properly, the load transfers to the next segment. This patient had cervical pain. Because the cervical spine was painful and restricted, he was avoiding using it fully and putting more load on the thoracic spine. But the thoracic spine does not have the same mobility as the cervical spine — it is not designed to take that load. So the excess load transferred further down, into the lower back. The lower back was the segment taking the force, not the segment causing the problem.

When we worked on improving thoracic mobility and reducing the cervical pain, the load on the lower back reduced automatically. The lower back pain that had not responded to lower back treatment resolved once we addressed what was happening two segments above it.

This is why I always assess the joint above and the joint below the area of pain. The spine is a chain. Treating one link in isolation while ignoring the others is how pain keeps coming back despite treatment.

The gap between what a surgeon expects after an operation and what a physiotherapist sees in rehabilitation is one of the most important and least discussed issues in patient recovery.

For a surgeon, a successful ACL reconstruction means the patient can walk, sit, perform basic activities, and has full range of motion. That is the surgical goal. But an athlete’s goal is to run, change direction, absorb impact, compete. That gap between walking and competing is entirely the rehabilitation phase — and most surgeons do not have the time or the specific training to bridge it.

I have seen this play out repeatedly. A surgeon tells a patient their exercises. Basic exercises. The patient follows them and plateaus. They come to me three months post-surgery still unable to run properly. The surgery was successful. The rehabilitation was incomplete. The detailed exercise progression, the sport-specific loading, the neuromuscular retraining — these require six to seven years of physiotherapy training to execute correctly. That is our specialisation, not a supplement to the surgeon’s work.

Surgeons and physiotherapists need to work together for patient outcomes to be complete. A successful surgery followed by poor rehabilitation is not a successful outcome. The patient comes back to the surgeon complaining of pain and the surgery gets blamed. Better communication between surgeon and physiotherapist prevents this. I always ask patients to share their surgical reports and discuss their surgeon’s expectations before we begin. Then I build from there.

When a patient has been in pain for two years and has seen multiple doctors and physiotherapists with no result, they walk in carrying something heavier than their physical injury. They carry frustration, lost hope, and a deep suspicion that nothing will work. If I ignore that and go straight to treatment, I am making the same mistake every previous clinician made.

In the first session with a long-term pain patient, I do no treatment. I only listen. I let them tell their entire history. Every treatment they tried. Every moment of hope that was followed by disappointment. By the time they finish speaking, I understand not just their condition but their experience of the condition. That is what I need to build a plan that will actually work for them.

I tell them a clear picture. Not a false hope. If someone has been in pain for two years, it is impossible and dishonest to promise results in five sessions. I tell them the minimum realistic timeline. Two months. Three months. Sometimes longer. I tell them that if they are not willing to commit to the process, I cannot help them. Not because I do not want to, but because the process requires both of us.

I never give false hope just to sell a package. Telling a chronic pain patient they will be better in ten sessions when you know they will not is not kindness. It is a disservice. A clear picture, even a difficult one, is what allows a patient to make a real choice about their recovery.