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Return to play or riding the pachyderm: a call for standards based on Swiss values
  1. Boris Gojanovic1,2
  1. 1Swiss Federal Institute for Sport (BASPO), Magglingen, Switzerland
  2. 2Sports Medicine, Department for Human Locomotion (DAL), Lausanne University and Hospital, Lausanne, Switzerland
  1. Correspondence to Dr Boris Gojanovic, Swiss Olympic Medical Center, Swiss Federal Institute for Sport (BASPO), Magglingen 2532, Switzerland; boris.gojanovic{at}

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Return to play (RTP) is an important issue in sports medicine; it is the other ‘bookend’ to effective prevention strategies for sports injury. Both share common goals and challenges and are critical to the multiple stakeholders in elite sports. RTP decisions are made in classical injuries such as sports concussion or ACL reconstruction, and are also made in infectious disease such as mononucleosis (splenic involvement) or frequently underdiagnosed myocarditis, and in less well-defined conditions such as disordered eating. Overuse injuries also present a challenge for RTP, whether in adolescents (apophyseal injuries) or adults (tendinopathies). While some of these conditions have clear diagnostic criteria, others do not and pose a greater problem with regard to readiness to play. Creighton et al1 have described a remarkable three-step model (medical factors, sport risk and decision modifiers) to facilitate decision-making.

The rational framework

A RTP decision requires accurate diagnosis, precise assessment protocols and tools, and, ultimately, capacity to correctly interpret these elements. A scientific algorithmic approach (multicomponent and sports specific) is …

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