Return to Sport

In a recent article in the British Journal of Sports Medicine, 17 expert clinicians discussed key issues in, and presented recommendations for, return to sport decision-making. Here’s a link to the article. If you are a coach, athlete, or clinician, I recommend taking a look. The following is a summary.

What is Return to Sport (RTS)?

Return to sport is just as it sounds, returning an athlete to their sport after injury or illness. But successful RTS may be defined differently by those who are involved–coach, clinician, and athlete. Collaboration is important; RTS is a process of shared decision-making. Several contextual factors guide RTS. These include: type of injury, age of the athlete, sport played, physical requirements, level of participation, significance of upcoming competitions, and social and financial costs.

Return to sport is not a decision that occurs at the end of a rehab program, rather it is a process that parallels recovery. There are three elements of RTS:

  1. Return to participation
  2. Return to sport
  3. Return to performance

Framework for RTS

A couple templates can be used to guide RTS. These include the StARRT framework and Biopsychosocial model. The StARRT framework is a 3 step process that includes the following:

  1. Assessment of health risk (what is the load a tissue can handle before it fails?)
  2. Assessment of activity risk (what is the expected load on tissues for a given activity?)
  3. Assessment of risk tolerance (what contextual factors [see above] influence risk?)

The biopsychosocial model considers biological, psychological, and social factors that may impact treatment and RTS. Pain is experienced by the person. Past experiences, fear of movement, expectations for care and RTS, and emotions all impact the pain experience. This is why predicting a timeframe for RTS can be so difficult.

Recall in a previous post that gradual and progressive overload is a key principle of training. This principle applies here too.

What is the Health Practitioner’s Role?

Using the above framework, clinicians can help determine readiness for RTS. In addition to treating and monitoring injury recovery, Chiropractors may use functional tests that challenge physical ability, including capacity to react and make decisions while fatigued. These functional tests are designed to replicate the sport experience. Psychosocial readiness should also be assessed. Talk to a practitioner you trust for more information.


Ardern et al. (2016). 2016 Consensus on return to sport from the First World Congress in Sports Physical Therapy, Bern. Br J Sports Med., 50(14)