Return-to-Play: Stages and Decision 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.