A Return-to-Performance Pathway for Professional Soccer: A Criteria-based Approach to Return Injured Professional Players Back to Performance

Injuries in football (soccer) have a significant impact on both financial and performance aspects. Research indicates that teams experiencing fewer injuries and higher player availability tend to achieve better results in the league compared to teams facing reduced availability and higher injury rates. The economic and competitive consequences of injuries raise the question of how professionals in high-performance settings can effectively facilitate players' return to performance (RTPerf). This analysis presents a structured approach and suggestions for an interdisciplinary team to guide the rehabilitation of an injured player from the initial injury phase, support their return to performance, and reduce the risk of further injuries (see Figure 1).

Figure 1: The 11-phase return-to-performance pathway (Mitchell and Gimpel 2024).

Upon the completion of acute injury management, it is essential to restore normal movement patterns, as well as enhance strength, endurance, power, and injury-specific functionality. The use of objective profiling is crucial in assessing the player's readiness to resume running activities (RTRunning). Subsequently, players are gradually reintegrated into sports-specific actions on the field. The rehabilitation process consists of six distinct phases: commencing with a reloading phase (Grass Phase 1), progressing to more demanding activities (Grass Phase 2), focusing on maximum speed and positional drills (Grass Phase 3), engaging in progressive team training sessions (Grass Phase 4), and eventually returning to gameplay (RTPlay) (Grass Phase 5). Once the player reaches or surpasses their pre-injury performance metrics, without any restrictions on match participation, they are deemed to have successfully returned to performance (Grass Phase 6).

The absence of clear objective criteria and variations in the benchmarks required prior to RTPlay increases the likelihood of inadequate rehabilitation, premature return to play, and the potential for re-injury. Inadequate communication and lack of clarity in terminology among key stakeholders further emphasize the necessity for a well-defined and concise pathway. The RTPerf pathway can be tailored to address mild, moderate, or severe injuries and has been developed based on evidence-backed criteria and precise terminology for each phase, aiding in decision-making and progression.

Reference

Mitchell, A. and Gimpel, M. (2024) ‘A Return-to-Performance Pathway for Professional Soccer: A Criteria-based Approach to Return Injured Professional Players Back to Performance’, JOSPT Open, 2(3), 166–178, available: https://doi.org/10.2519/josptopen.2024.1240.