Return-to-Sport and Return-to-Performance Decision-Making in Elite and Olympic Athletes from Flexibility-Dependent Disciplines: A Multidomain Clinical Framework

Background. Return-to-sport decisions in flexibility-dependent Olympic disciplines are often reduced to range of motion or pain relief, even though successful return requires tolerance to end-range loading, restoration of movement quality, psychological readiness, and sport-specific technical control. A clinically integrated framework for these athletes remains underdeveloped. Methods. This narrative review synthesized published literature on return-to-sport decision-making, stretching and flexibility training, kinesiophobia, training-load progression, and injury epidemiology in gymnastics, figure skating, artistic swimming, dance-related performance, and combat disciplines with high flexibility demands. Evidence was translated into a practical framework tailored to end-range sport. Results. The literature supports a multidomain model in which return readiness is determined not by a single flexibility milestone but by the interaction of symptom behavior, end-range load tolerance, movement quality, technical reintegration, psychological readiness, and coordinated coach-clinician judgment. Sport-specific risk concentrates in positions requiring repeated large-amplitude exposure under speed, impact, balance, or aesthetic precision. Accordingly, return progression should move from protected mobility to controlled end-range exposure, then to technical reconstruction, performance-specific density, and competitive readiness. Red flags include asymptomatic passive range without active control, loss of confidence near maximal amplitude, symptom rebound after training, and pressure to return before end-range capacity is restored. Conclusions. Elite athletes in flexibility-dependent sports require a broader return-to-sport model than conventional tissue-healing or ROM-based criteria. A staged multidomain approach may improve decision quality, reduce premature return, and better align rehabilitation with the technical realities of Olympic performance.