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‘Where is the load?’ Revisiting the Strategic Assessment of Risk and Risk Tolerance (StARRT) framework for return to sport by including an athlete’s sport-specific training capacity?
  1. Matt Taberner1,2,
  2. Daniel Dylan Cohen3,4,
  3. Anthony Carter5,6,
  4. Johann Windt7,8
  1. 1 School of Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
  2. 2 Performance and Medical Department, Orlando Magic Basketball Club, Orlando, Florida, USA
  3. 3 Masira Research Institute, University of Santander, Bucaramanga, Colombia
  4. 4 Sports Science Center (CCD), Colombian Ministry of Sport (Mindeporte), Bogota, Colombia
  5. 5 Faculty of Life Sciences and Education, University of South Wales, Wales, UK
  6. 6 School of Sport, Health and Exercise Sciences, Bangor University, Bangor, UK
  7. 7 Vancouver Whitecaps Football Club, Vancouver, British Columbia, Canada
  8. 8 School of Kinesiology, The University of British Columbia, Vancouver, British Columbia, Canada
  1. Correspondence to Dr Matt Taberner, School of Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK; matthewtaberner{at}

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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 …

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  • Twitter @MattTaberner, @danielcohen1971, @AntCarterphysio, @JohannWindt

  • Contributors MT proposed the article to JW, and MT wrote the initial draft. JW, DDC and AC edited the draft alongside MT until a final version was agreed between authors. MT updated the StARRT framework and created the table.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.