Return to play: the challenge of balancing research and practice

Life is full of risky decisions, from mundane ones, to matters of life and death.1 In professional football, risk is everywhere: For the club—the risk of having a poor season and loss of income by not qualifying for an important competition. For the manager—overseeing a bad run of results, potentially jeopardising his position. For the player—poor performance and, of course, injury. For the medical/science team—bringing a player back too early from musculoskeletal injury, and he/she suffering a reinjury. The dilemma is that, usually, riskier options promise higher returns.1 In football, the decision to progress or delay a player's return to play (RTP) after musculoskeletal injury could be the difference between having a key player back two games earlier (giving the best chance to earn six points) contrasted with keeping the player out for two extra games, lowering his/her reinjury risk, but potentially ending up with fewer points. Which risk is more important? Do we aim for a reinjury rate of 0%? Or might we settle for 10% recurrence, where every injured player is back one game earlier? RTP has been prominent …