841 © ESSKA 2018 V. Musahl et al. (eds.), Return to Play in Football, https://doi.org/10.1007/978-3-662-55713-6_64 Ethical Issues in Return to Play: How to Deal with Parents and Coaches Jeremy M. Burnham, Greg Gasbarro, Justin Arner, Thomas Pfeiffer, and Volker Musahl Contents 64.1 Introduction.............................................. 841 64.2 Principles of Return to Play .................... 841 64.3 Ethical Considerations ............................ 842 64.4 Psychological Aspects of Return to Play 844 64.4.1 Psychological Health of the Athlete ......... 844 64.4.2 Role of the Parents .................................... 844 64.4.3 Role of the Coaches .................................. 845 64.4.4 Role of the Athletic Trainers and Physical Therapists .................................................. 846 64.5 Objective Return-to-Play Criteria for Soccer: Injury-Specific Examples .......... 846 64.5.1 Concussion ................................................ 846 64.5.2 Anterior Cruciate Ligament (ACL) ........... 847 64.5.3 Ankle Injuries............................................ 847 References .............................................................. 848 64.1 Introduction The feld of sports medicine is unique in that the sports medicine professional is not only tasked with treating and interacting with the patient but must also skillfully navigate potentially complex relationships with an athlete’s parents and coaches. While the underlying principle of “frst, do no harm” still applies in sports medicine, medical decision-making and treatment algo- rithms are oftentimes made more complex by the temporal nature of sports seasons and the societal and economic pressures related to missed sports participation. For these reasons, it is crucial that sports medicine physicians have a clear under- standing of sound return-to-play (RTP) principles and adhere to strict ethical standards. By com- municating these guidelines early in the treat- ment process with the player, parents, therapists, athletic trainers, and coaches, all involved enti- ties will be on the same page, and RTP conficts are less likely to occur. 64.2 Principles of Return to Play Decision-making in terms of RTP following injury is a collaborative effort among the athlete, parents, guardians, coaches, physical therapist, athletic trainers, and team physician [1, 2]. Successful outcome is predicated on clear com- munication and goal-oriented rehabilitation. There is considerable empirical evidence that both parents and coaches infuence psychosocial well-being of youth athletes [3]. As such, there are multiple stakeholders involved in team sports that challenge the traditional notion of confden- tiality and autonomy. Ultimately, it is the respon- J.M. Burnham • G. Gasbarro • J. Arner V. Musahl, M.D. (*) Department of Orthopaedic Surgery, UPMC Center for Sports Medicine, University of Pittsburgh, 3200 S Water St, Pittsburgh, PA 15203, USA e-mail: musahlv@upmc.edu T. Pfeiffer Department of Orthopaedic Surgery, Traumatology, and Sports Medicine, Kliniken der StadtKoelngGmbH, Köln, Germany 64