Preprint / Version 1

Correcting recent misunderstandings of the StARRT framework for return-to-play decision making


  • Ian Shrier Centre for Clinical Epidemiology, Lady Davis Institute, McGill University



return-to-play, decision making, rehabilitation, injury


The Strategic Assessment of Risk and Risk Tolerance (StARRT) framework for return to play decision making follows a biopsychosocial causal philosophy for injury. A recent editorial in the British Journal of Sports Medicine suggested that the framework required modifications to incorporate “load”. However, the original framework already included load and the suggested modifications were based on a misunderstanding of the framework. Further, the power of the StARRT framework is in its simplicity which can be followed by any stakeholder (e.g. clinician, coach, participant).  The purpose of this article is to review and clarify how the StARRT framework is supposed to be applied, discuss that it already includes load, and demonstrate how it can be operationalized to specific contexts and implemented when designing load management strategies (training prescription) during rehabilitation.


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