Return to Play vs Return to Performance

Have you ever wondered how athletes like Tommy Turbo, Latrell Mitchell and Michael Hooper are able to recover from long stints on the sidelines and come back playing at their previous level? Thanks to a change in focus of sports medicine professionals, athletes at all levels, from junior representatives to the elite 1%, are able to make a greater impact when returning from injury.
While returning to play protocols are a critical component of sports medicine, there is now a recognition that it is not enough. Athletes must be able to return to their previous level of performance, which requires a more comprehensive approach to rehabilitation. We will discuss the difference between return to play and return to performance and why the latter should be the ultimate goal for injured athletes.

Return to play
Return to play refers to the process of an athlete being cleared by their medical team to participate in their sport again. This typically involves a series of objective tests and outcomes to assess the athlete’s physical ability to play. This is carefully coupled with healing times of the tissues injured to get an athlete to the field as soon as possible. However, return to play does not consider the athlete’s performance level before the injury. As a result, athletes may return to play but not be able to perform at the same level they did before the injury.

Return to Performance
Return to performance, on the other hand, is a more comprehensive approach to rehabilitation that takes into account an athlete’s pre-injury performance level. This approach focuses on not only restoring physical function but also on improving the athlete’s overall performance. This may involve psychological interventions, such as goal setting and visualisation, as well as sport-specific training and conditioning. This is not independent of the rehabilitation but introduced as soon as possible and integrated throughout. For example, a rugby union play with a lower limb injury will have adapted passing drills to maintain their level of performance.

Importance of Return to Performance
The ultimate goal of sports physiotherapy should be to help injured athletes return to their pre-injury level of performance. This not only benefits the athlete but also the team and the sport as a whole. Athletes who are able to return to their previous level of performance are more likely to be successful and contribute to their team’s success. Additionally, injury prevention needs to be part of this aspect of rehabilitation. This involves a focus on the injured area after the return to play/training. Therefore, rehabilitation will continue beyond the time spent off the field, pitch, pool, etc.

While return to play is an important step in the rehabilitation process for injured athletes, it should not be the goal. Return to performance is a more comprehensive approach that considers an athlete’s pre-injury performance level and focuses on improving their overall performance. By prioritising return to performance, sports medicine can help injured athletes not only return to play but also to excel in their sport once again.