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LEVEL OF EVIDENCE: 5 SUMMARY Background. Extreme sport participation occurs for many reasons. A commonality for many is the high risk of serious injury or death, particularly in association with mismanaged execution. Methods. This review describes a conceptual return to play decision-making model for extreme sport athletes based on considerations of ecological dynamics. Results. In guiding the extreme sport athlete through sport-specific training simulations and secondary injury prevention education, the rehabilitation clinician must develop a thorough understanding of the sport and the factors that contribute to their safe performance. Conclusions. The interaction of multiple factors including (but not limited to) experience and skill level, personality, conditioning level, overall health and injury status and the injury risks associated with many extreme sports make return to play decision-making particularly difficult.

An Ecological Dynamics Perspective of Return to Play Decision-Making for Extreme Sport Athletes