What is the role of milestones in return-to-play progression?

• A. Milestones are optional and not tracked
• B. Milestones represent readiness to advance when achieved with symptom response
• C. Progression should be time-based only
• D. Milestones should be set solely by coaches

Answer: (B)

Milestones are objective checkpoints that signal when it’s appropriate to move to the next stage of return to play. They combine symptom status with functional readiness, so progression isn’t based only on how much time has passed. When a milestone is reached, meaning the athlete has no new or worsening symptoms and can meet the required functional tasks for that stage, advancing to the next level is appropriate. If symptoms flare or performance criteria aren’t met, progression pauses or regresses until the athlete demonstrates adequate recovery again. This approach keeps the plan athlete-centered and safety-focused, ensuring loads are tolerated and the risk of reinjury is minimized. Milestones are typically set with input from medical staff and coaches to reflect sport-specific demands, and they provide a clear, standardized path back to competition. For example, milestones might include achieving full range of motion, symmetric strength, and the ability to perform sport-specific movements without symptom provocation.