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Illness or injury affected four out of every five athletes on the Great Britain Track and Field Team before, during or immediately after the 2012 Olympic Games. 1 The return to play (RTP) decision is a case of risk management, and athletes may continue to train or compete, despite being ill or injured. This begs the question:‘How is the return to play decision made in elite sport’? RTP decisions are complex, specific to the athlete and type of sport, and often influenced by ‘decision modification’factors (eg, pressure to return for a major event). 2 In the case of a sprinter with a hamstring strain 2weeks from the World Championships, the final RTP decision-maker might be the athlete. However, the healthcare professional should be the final RTP decisionmaker when athlete decision-making capacity is compromised (eg, concussion). Decisions regarding the immediate medical management (including