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

Abstract

BACKGROUND: Injuries in football (soccer) have a huge financial and performance impact. Teams with fewer injuries and higher player availability have been shown to finish higher in the league than teams with reduced availability and higher injury rates. CLINICAL QUESTION: Given the economic and competitive implications of injury, how can high-performance practitioners guide players’ return to performance (RTPerf)? KEY RESULTS: We share a rehabilitation framework with clear progressions and objective criteria to guide decision making at each phase. Upon completing acute management, normal movement patterns are restored, along with strength, endurance, power, and injury-specific function. Objective profiling helps to determine readiness to return to running (RTRunning). Once running, players are reintroduced to on-field sports-specific actions. Players progress through 6 phases, starting with a reloading phase (Grass Phase 1), moving on to more intensive actions (Grass Phase 2), maximum speed and positional drills (Grass Phase 3), and a progressive team training period (Grass Phase 4) before returning to play (RTPlay) (Grass Phase 5). Upon reaching previous injury metrics or higher, with no restrictions on match exposure, the player has returned to performance (Grass Phase 6). CLINICAL APPLICATION: An 11-phase RTPerf pathway includes examples for practitioners of objective criteria for each phase. The pathway can be adapted for different injury scenarios. JOSPT Open 2024;2(3):166-178. Epub 24 May 2024. doi:10.2519/josptopen.2024.1240