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It is time for consensus on return to play after injury: five key questions
  1. Clare L Ardern1,2,
  2. Mario Bizzini3,
  3. Roald Bahr1,4
  1. 1Aspetar Orthopaedic & Sports Medicine Hospital, Doha, Qatar
  2. 2Division of Physiotherapy, Linköping University, Linköping, Sweden
  3. 3F-MARC (FIFA Medical Assessment and Research Centre), Schulthess Clinic, Zurich, Switzerland
  4. 4Department of Sports Medicine, Oslo Sports Trauma Research Centre, Norwegian School of Sports Sciences, Oslo, Norway
  1. Correspondence to Dr Clare L Ardern, Aspetar Orthopaedic & Sports Medicine Hospital, P.O. Box 29222, Doha, Qatar; c.ardern{at}latrobe.edu.au

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Questions

“When will I be able to play again?” is usually the reflex thought when an athlete suffers an injury. When making return-to-play decisions, clinicians (including physiotherapists, athletic trainers and physicians) and athletes might engage in a risk–benefit analysis of sorts, consciously or unconsciously weighing up the risks associated with participation and the extent to which those risks can be tolerated.1 There are a number of questions to contemplate: How does the clinician determine when the athlete is ready to return to play? Is physical recovery alone enough for return to play? What is successful return to play? What are the sports medicine clinician's responsibilities within the team, and to the athlete? Should athletes even return to play?

But what evidence can be used to answer these questions? We highlight some of the complexities in making the return-to-play decision, and key areas that need to be addressed.

Answers?

How does the clinician determine when the athlete is ready to return to play?

In the traditional evidence-based practice model,2 the clinician integrates the best available evidence from research with individual clinical experience and the patient's preferences when making decisions. In the search for the best evidence, considering an ankle sprain, the clinician might consult a textbook, where the evidence says that the athlete should have no pain or swelling, full strength and range of motion, and a healed ligament before returning to full competition.3 The time taken for pain and swelling to subside and full range of motion to return might vary from a couple of weeks to a couple of months; it may take a year for ligament healing.4 But in real life …

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