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Return to play? What the scientific literature says!

Summer is about to come to an end (😢), marking the end of sunny vacations and the start of a new sporting season for our athletes. For top athletes and their medical teams alike, this is a crucial transition period that will have a major impact on the coming season. Returning to sport at a highly competitive level, while exercising safely and within a reasonable timeframe: that's the pressure our athletes are under. This is what we call "return to play", a term that encompasses much more than a simple return to sport.


Return to play: a decisive stage


The term return to play is more commonly used to designate the work carried out by medical teams to enable an injured player to return to competition. It's the green light given by practitioners to get back on the pitch.


For our players returning from Ibiza with an extra 3kg, the physical and mental preparation required to get back on the field will be just as important. Indeed, the return to play is the moment when the desire to get back on the pitch and to match the performances of the previous season meets with the imperative need to train with care. But, as in all things, the quest for performance can quickly lead to carelessness and haste... And in the case of our athletes, missteps can lead to cruciate ligaments or other injuries that can quickly put an end to the current season... Or at least complicate it!


As mentioned at the start of this article, return to play refers to a player's ability to return to the field. In the case of injury recovery, this is not a decision to be taken lightly. Even less so today. In the past, only a surgeon's decision could be considered a green light. In other words, he or she would set a return date based on the injury, and that was that. Back to training and/or competition.

You see the problem too, don't you? Returning to sport is good, but returning to sport safely is even better. Especially for professional athletes, for whom an injury can affect an entire season, or even an entire career. The transition period between injury and return to sport is therefore crucial. Grégory Marquet, physical trainer for the former Top 14 team, outlined 5 stages in his interview with Med'Score.


  1. Tests to determine whether you can return to training without any real deficit

  2. Re-athletization

  3. Physical preparation

  4. Return to competition (return to play)

  5. Return to performance.

Steps confirmed by the Consensus statement on return to sport from the First World Congress in Sports Physical Therapy 2016 in Bern, which spoke of:


  • Return to participation: the athlete is physically active, but is not yet "ready",

  • Return to sport: the athlete has returned to sport but is not achieving the desired level of performance, although some may be satisfied to have reached this stage,

  • Return to performance: the athlete performs at or above injury level.


Throughout these stages, functional and psychological tests will be carried out to determine the return-to-play deadline. In this way, the decision will no longer be based solely on the estimated recovery time from injury, but on the player's own feelings, as he or she will inevitably want to return to the field as soon as possible.



Return to Play in the scientific literature


This new return-to-play process would appear to be the key to limiting the risk of muscle rupture and/or re-rupture following reintegration on the field. In this context of return to competition, numerous studies have been carried out to determine the percentage of recurrence of muscular injuries in athletes. This percentage varies according to the sport practised, the type of injury and the specific population studied, but can nevertheless be as high as 30%. A rate that seems to be reduced by ensuring the player's ability to return to the field. Psychologically and physically.


Validation of psychological tests


The psychological aspect appears in numerous studies ( Pain in elite athletes-neurophysiological, biomechanical and psychosocial considerations: a narrative review, and the Consensus statement on return to sport from the First World Congress in Sports Physical Therapy) and is now an inseparable part of RTP. An injury, or a long break from sport, can challenge an athlete's resilience, test his nerves and patience, and may alter his decisions regarding his return to play. It will therefore be important to follow the athlete through this process to help him or her accept their current status, while maintaining motivation and confidence for the future. Tests such as the scientifically validated Sirsi allow for this self-assessment.


As an aside: if you're interested in the psychological impact on athletes of stopping sport, I recommend you read this article 😉: https://pubmed.ncbi.nlm.nih.gov/27285354/


Validation of physical tests


Now it's on to the physical tests, where every jump becomes a meticulous assessment of muscle deficits. Indeed, jump assessments play an essential role in the return-to-play process. They reveal hidden weaknesses and dominant strengths. For athletes and practitioners alike, this data is invaluable, as it can indicate whether or not the body is ready to resume activity. And if it isn't, it will indicate the deficits that need to be remedied. Who would have thought that a simple jump could tell you so much... Anyway, the point is to tell you that certain evaluation criteria regularly appear in the literature, and these criteria are: motricity, neuro-muscular control, muscular balance and strength.

And it's probably for this reason that isokinetic and K-START tests are the most frequently mentioned in the success of RTP. The Bilan Blueback Physio could also be used in this context. It would provide objective data on the integration capacity of the transversus abdominis for safe reintegration.


All these assessments will be combined with clinical tests. Then comes the work of reathletization, endurance and resistance to fatigue.


As you can see, preparation for return to play is not a simple process. It's different stages that requires the involvement of a variety of medical and sports professionals. Every test, every assessment and every step contributes to shaping athletes' successful return to the field. Recognize, assess, reassess, rest, rehabilitate, orient, recover, return to sport, reconsider, after-effects and risk reduction. That's what return to play is all about.


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