Revisiting the StARRT framework

The Strategic Assessment of Risk and Risk Tolerance (StARRT) framework has been instrumental in the way practitioners view return-to-sport (RTS) decision-making.1 2 According to the framework, RTS decisions should be based on the practitioner’s risk assessment of outcome, involving an athlete’s estimated risk compared with their risk tolerance within the particular context. Activity risk assessment is the second step in the StARRT framework, synthesising information relevant to the expected cumulative stresses placed on the injured tissue/structure(s). Several important factors are included in this assessment, but what is not listed is the athlete’s sports-specific training capacity. This represents an athlete’s overall ability to cope with diverse demands of training and competition imposed by their ecosystem and perform at the required level. It is perhaps the most ecologically important consideration since it encapsulates the ‘actual’ demands and requirements of the athlete’s sport and their level of participation.3–5 While the importance of monitoring training load in rehabilitation has been established,6 7 we emphasise that sufficient consideration has not been given to the role of the athlete’s sports-specific training capacity in decision-making …