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When can athletes return to play? Stanford researchers provide guidance

Amidst concerns about the growing number of concussions and other injuries sustained by youth athletes, a panel of researchers led by Stanford's Gordon Matheson, MD, has developed a new three-step framework for physicians to use in assessing when players are ready to return to competition.

The model (subscription required), which was published this month in the Clinical Journal of Sport Medicine, is structured to evaluate the athlete's health status, his or her risk of repeat injury, and external influences, such as pressure from coaches, that can impact return-to-play decisions. Numerous medical and non-health related factors are also addressed in the guidelines, including the type of sport and the athlete's injury history and readiness to resume play.

In the article, researchers discuss the importance of using an evidence-based model to determine when players have fully recovered from an injury.

Previous injury is associated with up to a 4-fold increase in the risk of reinjury, and the treatment of all injuries includes advice on when it is safe to resume sport participation. For this reason, return-to-play decisions are critical to the practice of clinical sport medicine. In general, previous research related to return-to-play decision making has focused on conditions with serious long-term morbidity or potential mortality such as concussion, spinal cord injuries, and cardiovascular abnormalities. Even though musculoskeletal trauma represents the majority of injuries in sports medicine, there is little original return-to-play research for them. In the absence of clear scientific evidence, return-to-play decisions lack standardization and can be a source of confusion and disagreement for physicians, athletes, coaches, and administrators.

Photo by Anne Rossley

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