Return to Sport Decision Making Considerations

Thoughts from: Dr. Michael Reinhardt, PT, DPT, OCS| Performance Physical Therapist, Resilient PT

Is there continued pain, significant alterations in movement strategy, or a considerable fear of re-injury?

Research has shown that an athlete’s subjective perception of their current readiness is an important indicator of their ability to return to sport. If an athlete is reporting that they do not feel confident returning, additional questions need to be asked and explored.

Have relevant joint ROM and isolated strength capabilities been restored?

Insufficient local strength capacities can significantly impair performance and heighten risk of subsequent injury.

Can the athlete demonstrate relevant force application?

The magnitude (peak forces), speed (velocity of contraction), direction, frequency, and rate of force development should all be considered and demonstrated in progressively more chaotic situations as they pertain to the particular athlete’s demands.

Are all stakeholders aware of and in agreement with the return to sport decision?

Stakeholders could include the athlete, the parents/family, coaches, and the team(s) that the athlete plays for. Keep in mind that different stakeholders may have competing interests. For example, a team/coach may want their star player to be back for an important game, even if that player is not yet ready to return.

Do the benefits of return to sport outweigh the potential downsides at this time?

Return to play is primarily a matter of weighing the upsides with the potential downsides. There is no such things as “injury prevention,” but we can use our current understanding of the situation, the interests of the player in front of us, and the physical and psychological readiness of the athlete to assist in this decision making. If there are notable physical and/or psychological barriers to returning to sport, the athlete may not be ready to return to full play. In such instances, the player may benefit from additional reps in practice, scrimmages, and with strength and conditioning progressions in order to overcome any remaining impediments.


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