Return to play in elite sport: a shared decision-making process

Illness or injury affected four out of every five athletes on the Great Britain Track and Field Team before, during or immediately after the 2012 Olympic Games.1 The return to play (RTP) decision is a case of risk management, and athletes may continue to train or compete, despite being ill or injured. This begs the question: ‘How is the return to play decision made in elite sport’? RTP decisions are complex, specific to the athlete and type of sport, and often influenced by ‘decision modification’ factors (eg, pressure to return for a major event).2 In the case of a sprinter with a hamstring strain 2 weeks from the World Championships, the final RTP decision-maker might be the athlete. However, the healthcare professional should be the final RTP decision-maker when athlete decision-making capacity is compromised (eg, concussion). Decisions regarding the immediate medical management (including RTP) of an ill or injured player on the field of play should be made by a healthcare professional. The coach or manager should have no say in whether the medical team should attend the athlete, or in immediate player assessment.3 …