Return-To-Play for Injured or Ill Athletes
Abstract & Commentary
Synopsis: An injured or ill athlete should be returned to practice or competition without putting the individual or others at risk for injury or illness.
Source: Herring SA, et al. Med Sci Sports Exerc. 2002; 34(7):1212-1214.
This statement was developed by the collaborative effort of 6 professional associations concerned with sports medicine issues, including the American Academy of Family Physicians, American Academy of Orthopaedic Surgeons, American College of Sports Medicine, American Medical Society for Sports Medicine, American Orthopaedic Society for Sports Medicine, and the American Osteopathic Academy of Sports Medicine. The goal of the statement is to provide guidelines that can be used to return an injured or ill athlete to practice or competition without putting the individual or others at undue risk for injury or illness. To this end, the statement explains that team physicians should establish a return-to-play process, and have knowledge of evaluation, treatment, and rehabilitation of injured and ill athletes.
To establish a return-to-play process, the team physician should establish a decision-making chain of command, communicate the process to athletes, families, coaches, and other involved health care providers, establish a system for documentation, and create protocols for release of information regarding an athlete’s ability to return to play. In addition to addressing the safety of the athlete, the process should address the potential of risk to other participants, functional capabilities of the athlete and requirements of the sport, and pertinent governing body regulations related to return to practice or competition.
The statement provides guidelines regarding the evaluation, treatment, and rehabilitation of injured or ill athletes that are intended to be a guide rather than standard of care. A sound understanding of these guidelines enables the team physician to confirm return-to-play criteria related to healing, status of recovery, restoration of sport-specific skills, psychosocial readiness, and the role of equipment and bracing as an adjunct to return to practice or competition.
Comment by David H. Perrin, PhD, ATC
Returning an injured or ill athlete to play is one of the most difficult decisions made by the sports medicine team. The safety of the athlete should always be foremost in the mind of the overseeing health care provider. External influences such as pressure by family, coaches, and the perceived importance of winning should never override a sound decision based on objective and pre-established criteria.
Some amount of subjectivity will invariably enter into return-to-play decisions, and for this reason all members of the health care team should be involved in the process. The team physician should have final authority, based on input from the athlete, certified athletic trainer, coach, and any other health care providers who have been intimately involved with the care of the injured or ill athlete.
The statement correctly points out that appropriate return-to-play decisions are best made by professionals having a sound understanding of the evaluation, treatment, and rehabilitation of athletes. The organizations involved in the creation of this statement provide a plethora of educational opportunities for the interested sports medicine health care provider. These opportunities can be found by visiting the following web pages: www.aafp.org; www.aaos.org; www.acsm.org; www.amssm.org; www.sportsmed.org; and www.aoasm.org.
Dr. Perrin, Dean, School of Health and Human Performance, University of North Carolina—Greensboro, is Associate Editor of Sports Medicine Alert.
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