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Update on functional recovery process for the injured athlete: return to sport continuum redefined

The traditional functional recovery model and return to sport (RTS) decision-making process after long-term injury is insufficient in the real world of sports medicine. There are lower than ideal numbers of athletes returning to competitions after certain injury types.1 2 Additionally, those who do RTS have heightened risk of reinjury,3 may not return to preinjury performance levels,4 or may be unable to sustain the same level of competitive play in the subsequent years after injury.5 This paper provides an update on the RTS process, reflecting the new literature and knowledge in the area as well as applied practice, to support practitioners working with athletes after injuries and in particular after severe injuries (>28 days).6 

A dichotomous conception of functional recovery was common in the past (and often still present) which involved the separation of clinical rehabilitation and RTS. Initially, the patient begins with the medical team before been transferred to the performance team (coaching and fitness staff) for sport-specific training and RTS. There is often little or no overlap in the process, and limited communication and sharing of knowledge during the functional recovery process.

When there is a need to prepare the athlete for direct re-entry into sport after injury, it is necessary to consider an overlap of the rehabilitation and RTS processes. This area of overlap …