Return to Sport Testing

Return to sport testing is still a process that is (in my opinion) under utilized.  However, part of the reason I believe more clinicians don't do consistent return to sport testing is because they are unfamiliar with the process.  The research has demonstrated step by step how to do many of the tests that have been validated and reliable but they don't show us how.  Fortunately, there are now many videos showing us how to do them (see here for example).  Yet, knowing how to do the tests aren't enough.  In this article, I am going to show you the benefit of performing return to sport testing batteries at multiple stages of rehabilitation vs one big return to sport test.  

In the past, performing hop tests was considered a good return to sport test.  However, we have learned so much about returning an athlete back to sport.  There are many factors to consider when returning an athlete to sport.  

                                                  "When will I be able to compete again?"

The first thing we have to do  is define what return to sport is.  Many still interchange return to play and return to sport.  The return to sport process must be defined by sport & level of sport.  For example, is the athlete a billiards player or a soccer player?  Furthermore, if we take the soccer player example is the player a recreational league player or an English Premier League player? These questions must be answered when considering return to sport.  

Now that we have defined return to sport, we have to understand all the possible contextual considerations.  Those can include the following:

​- Type of injury (acute vs chronic)
- Type of sport (individual vs team sport, contact vs non-contact sport)
- Level of participation (recreation vs collegiate vs professional)
- Physical demands (multi-directional, cutting, jumping)
- Significance of upcoming games (goes back to level of participation)
- Social & financial implications
- What is successful return to sport? (being on the field performing vs being the MVP)

As you can see, there is a lot to consider.  This is why return to sport has evolved to be a continuum.  The athlete evolves in the rehabilitation process from return to participation to return to sport to return to performance.  Educating our athletes and the other stakeholders (MD's, trainers, agents, parents, coaches, etc) in this model is crucial to avoid miscommunication and establish trust.  

This leads into the next step of return to sport which is the current models that help us with our decision making.  Those include:

1. StARRT Framework
2. Biopsychosocial Model

The above represent the paradigm shift towards criteria based approach to RTS vs time based approach.   For those that are unfamiliar with the StARRT framework, see the below picture.  In other words, step 1 asks us: how much load can the tissue handle? Step 2 asks us: how much load do we expect upon return to sport? Step 3 asks us: what contextual factors may influence RTS decision?

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The Biopsychosocial model further evaluates the athletes psychology.  We have learned over the last decade how important this is.  Without evaluating this, we are missing out on a big contributing factor with a successful vs non-successful RTS.  To summarize, the biological, psychological, and social components play a big role. 

As you can see, there is a lot to consider with return to sport.  This is exactly why performing one grand finale test is not efficient or enough.  We need to appreciate the continuum that RTS is.  Testing batteries should be designed to help us make better decisions about what we need to improve with our treatment & training program for our athlete.  Furthermore, being able to re-test can help us determine if our programs were sound enough to make a change.   In future posts I will demonstrate example testing batteries I perform with videos for better clarity.  

My question for you is: Do you regularly perform RTS testing batteries?  If not, why?  


Dr. Brian Schwabe, PT, DPT, SCS, COMT, CSCS
Board Certified Sports Physio
USC Sports Residency Trained

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