“Return to Sport” is often seen in rehab as this magical day in which the athlete will be able to return to full participation in their sport, with their team, at the same level they had been at prior to the injury, as though the injury/illness never happened at all.
Instead, RTS should be viewed as a continuum throughout the rehabilitation and performance spectrum.
The 2016 Consensus statement on return to sport from the First World Congress in Sports Physical Therapy, Bern discusses this continuum of RTS as having three stages.
In the Return to Participation phase, the athlete may be able to participate in modified or full training sessions, modified time or different roles in a game/match/competition, but they are not yet playing at the desired level. This could be for a number of different reasons including stage of tissue healing, physical fitness, mental preparedness, or any other contextual factor keeping them from fully returning to sport.
The Return to Sport phase can often times be the point at which the athlete has decided they have successfully completed return to sport. For example, a college soccer player who tears her ACL in the end of her senior season and has no expectations of playing professionally might be satisfied with being able to return to playing soccer recreationally. She would not be participating at the same level as she was previously, but the contextual factors have made her satisfied with achieving this level of return to sport.
The Return to Performance phase is when the athlete has met or exceeded the level of performance they were at pre injury. The athlete is working towards higher performance goals, achieving PR’s, and has improved metrics of performance than prior to the injury/illness.
It is important to be able to progress and regress athletes through this continuum and to understand the contextual factors playing into the RTS decision making process.
Ardern CL, Glasgow P, Schneiders A, et al 2016 Consensus statement on return to sport from the First World Congress in Sports Physical Therapy, Bern Br J Sports Med Published Online First: 25 May 2016. doi: 10.1136/bjsports-2016-096278