Return-to-Play: Stages and Decision Criteria
Return-to-play is the structured progression from injury through rehab back to full competition, gated by objective criteria.
Key takeaways
- Three stages: participation → sport → performance
- ≥90% limb symmetry as a guideline, not a rule
- Psychological readiness matters as much as physical
- Shared decision-making, not coach-only
Definition
Return-to-Play (RTP) is the criteria-driven progression from injury through rehab, return-to-training and finally return-to-competition. The current consensus (Ardern et al.) emphasises shared decision-making between athlete, coach, physio and medical staff.
The three-stage model
Return to Participation: athlete trains at a reduced level with monitored load.
Return to Sport: athlete completes full training with sport-specific demands.
Return to Performance: athlete reaches or exceeds pre-injury performance benchmarks.
Decision criteria
Pain-free ROM symmetry, ≥90% strength symmetry, hop-test symmetry, sport-specific drill completion and psychological readiness (TSK, ACL-RSI). No single test is sufficient.
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