In professional sports, return-to-play decisions are often framed as physical milestones when strength is restored and key metrics are met. However, many rehabilitation programs still overlook a crucial variable: psychological readiness.

An athlete may be medically cleared, but not mentally prepared. That gap carries consequences.

Across sports, research consistently shows that psychological factors, such as fear of reinjury, confidence, identity disruption, and perceived readiness, play a decisive role in both athletic performance and reinjury risk. Conversely, mental health conditions themselves can increase injury risk, reinforcing the need to address psychological factors throughout rehabilitation. Athletes who return to competition without full psychological readiness are more likely to hesitate in high-pressure moments, potentially risking recurrent injury, as well as underperform relative to their baseline.

Multiple studies in sports medicine demonstrate that athletes with lower psychological readiness scores following injury, especially after ACL reconstruction, deal with significantly higher rates of reinjury and reduced likelihood of returning to prior levels of performance. A validated scale that reliably predicts return-to-sport outcomes is the ACL-Return to Sport after Injury (ACL-RSI), a 12-item questionnaire that evaluates confidence and psychological readiness. There are now a few validated scales that measure key components like confidence and fear of reinjury. However, how many are being administered or utilized in professional sports? It is clear that mental and physical health are........

© Sports Business Journal