Return to Sport (RTS)

The most common question athletes ask after an injury is, “When will I be able to return to my sport?” The answer is more complex than it may seem and depends on multiple factors. For each athlete, “return” may carry a different meaning, but during rehabilitation we generally distinguish three key stages.

1. Return to Training. The first step is returning to training. At this stage, the athlete resumes practice under specific participation guidelines, follows a personalized rehabilitation program, and gradually gains increasing independence.
2. Return to Sport. In this phase, the athlete can participate fully in training sessions, sport-specific drills, and even competition. However, performance level and technical execution may not yet have returned to pre-injury standards.
3. Return to Previous Performance Level. At this stage, the athlete has fully recovered from the injury, resolved any associated deficits, restored physical conditioning, and regained technical proficiency.

• Can you tell me exactly when I’ll be able to return?

Unfortunately, no. Although general rehabilitation protocols exist based on approximate timelines, every body responds differently. The assessment and initial treatment do not provide all the information required to accurately predict recovery duration.

It is important to understand that throughout your rehabilitation process, we continuously reassess your progress and set short-term and long-term goals. Once these goals are achieved, they allow for a safe progression toward return. During treatment, we evaluate the presence or absence of pain, the frequency and type of symptoms, and any deficits in range of motion or muscle strength. Only through consistent monitoring can we establish a realistic timeline for your return.

• What happens if I return too early?

The greatest risk of returning prematurely is re-injury. Injury, in general, is a risk inherent in daily life and sport, and it cannot be completely eliminated. However, re-injuring an already affected area typically leads to a longer rehabilitation period, extended time away from activity, and often a negative psychological impact on the athlete.

It is essential to remember that the body requires time to heal—whether the injury is visible externally or internal at the tissue level.

• What criteria do you evaluate before allowing me to return?

A key factor we consider when discussing return to training or competition is the specific sport you participate in and its unique demands. Biomechanical requirements, the type of sport (collision sports, contact sports, etc.), your competitive level, and the stage of the season all influence the rehabilitation plan and return-to-play decision.

Additionally, we evaluate your clinical presentation. We assess whether symptoms have resolved, whether strength and range of motion have improved, and whether any new symptoms have appeared—something that can occur after injury due to compensatory movement patterns.

Depending on the type and location of the injury, we perform clinical tests to compare the injured limb (e.g., right knee) with the healthy limb (e.g., left knee) across parameters such as strength, endurance, range of motion, stability, and proprioception.

Beyond the clinical findings, we place great importance on your psychological readiness. Confidence, absence of fear, and feeling mentally prepared to return are just as critical to performance as physical recovery.

No matter how long the process takes, our priority is ensuring that your return to sport is safe and well-guided. This can only be achieved through structured progression and clear instructions. We stand by your side to help you reach your goal as efficiently and safely as possible.

References

Ardern, C. L., Glasgow, P., Schneiders, A., Witvrouw, E., Clarsen, B., Cools, A., Gojanovic, B., Griffin, S., Khan, K. M., Moksnes, H., Mutch, S. A., Phillips, N., Reurink, G., Sadler, R., Silbernagel, K. G., Thorborg, K., Wangensteen, A., Wilk, K. E., & Bizzini, M. (2016). 2016 Consensus statement on return to sport from the First World Congress in Sports Physical Therapy, Bern. British Journal of Sports Medicine, 50(14), 853–864.

Creighton, D. W., Shrier, I., Shultz, R., Meeuwisse, W. H., & Matheson, G. O. (2010). Return-to-Play in Sport: a decision-based model. Clinical Journal of Sport Medicine, 20(5), 379–385.

Della Villa, S., Boldrini, L., Ricci, M., Danelon, F., Snyder-Mackler, L., Nanni, G., & Roi, G. S. (2011). Clinical Outcomes and Return-to-Sports participation of 50 soccer players after anterior cruciate ligament reconstruction through a Sport-Specific rehabilitation protocol. Sports Health: A Multidisciplinary Approach, 4(1), 17–24.

Wulff, M. W., Mackey, A. L., Kjær, M., & Bayer, M. L. (2024). Return to Sport, Reinjury Rate, and Tissue Changes after Muscle Strain Injury: A Narrative Review. Translational Sports Medicine, 2024(1), 2336376.

Rafaela Agagioti
Physiotherapist