A patient's mental preparedness, confidence and fear of re-injury, when returning to sport.
Psychological readiness refers to a patient's mental preparedness to return to sport following injury, encompassing their confidence in the injured body part, their appraisal of re-injury risk, and residual fear of re-injury or harm. It is distinct from physical readiness (strength, range of motion, functional performance) and represents a separate domain that should be assessed alongside it.
Clinicians often clear patients based on physical milestones alone, yet psychological readiness independently predicts whether an athlete actually returns to their prior level of sport and their risk of subsequent injury. Recognising low psychological readiness opens a conversation about graded exposure, confidence-building, or referral for psychological support, rather than assuming a physically capable patient is ready to play.
It is most commonly assessed using self-report questionnaires such as the ACL Return to Sport after Injury (ACL-RSI) scale, which asks patients to rate emotions, confidence and risk appraisal related to returning to sport. Scores are typically used alongside physical and functional testing as part of a multifactorial return-to-sport decision, and can be tracked serially through rehabilitation to monitor change.
Self-report tools are subject to social desirability bias and may not capture fluctuating confidence day to day, so a single score should not be used in isolation to clear or withhold return to sport. There is no universally agreed cut-off score indicating readiness, and tools like the ACL-RSI were developed and validated primarily for ACL reconstruction populations, so their applicability to other injuries or sports should be considered carefully.
This guide was auto-drafted and is pending editorial review.