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Practitioner Survey Highlights Optimal Return to Play Process in Elite Football


Martin Buchheit


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Injuries to professional athletes can affect team performance and morale, not to mention the bottom line. On average, English Premier League teams lose approximately £45 million per season due to injury-related decrements in performance. Therefore, return-to-play (RTP) strategies aimed at bringing players back to competition in the shortest time possible while reducing the risk of re-injury are of keen interest.

Today, there are several resources available recommending the optimal process to follow, including specific screening protocols and suggested cut-off values for progression criteria and overall RTP decision-making.

However, much of this information is hamstring-specific. In addition, several practical, real-life questions practitioners face on a daily basis have yet to be examined.

To address these questions, we recently published new research titled Return to play following injuries in pro football: insights into the real-life practices of 85 elite practitioners around diagnostics, progression strategies and reintegration processes.

New Practitioner Survey Looks at RTP Process

Our survey was designed to gain insight into how practitioners approach, manage, and deliver the “return to play” process in real-life conditions. It consisted of 62 questions and polled 85 elite practitioners in top football clubs.

The aim was to answer key practical questions around clinical diagnosis, the use of progression criteria, players’ reintegration with the group/competition, and the overall organization of the RTP process within the Multi Disciplinary Team (MDT).

Survey Results: Key Takeaways

The survey findings highlight the variety of ways elite sports practitioners manage their injured athletes. The value of this particular survey is that practitioners were asked to answer questions regarding what they have experienced and not necessarily what they think would be optimal. Here is a summary of the key points:

    • The RTP process appears as the most collaborative phase in which players may be involved throughout the season.
    • While it’s obviously heavily doctor/physio-led (from the diagnostic to setting the progression phases), other professionals take part actively (e.g., strength & conditioning coaches working in duos with the physios, and sometimes assistant coaches helping the latter on pitch-specific sessions) or more passively (e.g., head coach and sporting director when making the decision to let go of a player to get rehabbed outside of the club).
    • The three main elements consisting of: 1) the player (e.g., status, history, beliefs, culture), 2) his injury type and severity, and 3) the context (e.g., calendar, coach pressure), constantly interact together making each case unique.
    • The entire RTP process needs to be as flexible as possible (from the different progression phases to the group reintegration to train and compete) and benefits from continuous monitoring of both the contents and the outcomes.

Examples of key specifics results:

      • The most important drivers for players’ progression are their progress measured against baselines or return to function measures, and not overall time loss and injury duration.
      • Sending players on the pitch without having “ticked all the boxes” is a very common practice, especially for low-severity injuries (70% of the time all criteria are not met).
      •  Players were reported to be sometimes selected in the group for a match without having met all the most important RTP criteria – the shorter the unavailability, the greater this latter occurrence [reaching near-to-normal baseline (ROM, mobility, maximal strength) and speed exposures appeared to be the most important criterion not to miss though].

While some aspects of the return-to-play process are well known and documented, this new research gives practitioners a better understanding of how the practical aspects of the process are implemented and managed in a professional football environment.

We encourage you to read the complete research paper to fully understand the survey methodology, data analysis, full results, limitations, and more.

For any questions or additional information, please reach out to one of our performance experts at



  • Performance Medicine
  • PIRI
  • Soccer
  • Sports Medicine EMR/EHR
  • Sports Performance Analysis

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  • Martin Buchheit

    Dr. Martin Buchheit is a strength and conditioning coach who progressively developed into an applied sport performance scientist, mainly focusing on football (soccer). He worked and consulted worldwide in various sports.


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