Adaptive Return-to-Performance Systems Model: An Allostatic Framework for Readaptation and Recovery

Sports injuries represent a major challenge in exercise and sports sciences, compromising physical, psychological, and professional well-being. Traditional rehabilitation has been guided by a homeostatic model, where recovery is defined as restoring altered variables to baseline levels. However, this reductionist view overlooks the systemic and dynamic processes involved in healing. Allostasis provides a broader perspective by conceptualizing recovery as an adaptive, multisystem process rather than a static return to a pre-injury state. This study was conducted as a narrative review to synthesize and integrate current theoretical and empirical evidence on the role of allostasis in sports injury rehabilitation. A structured search of PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar (2000–2025) was performed using predefined keywords related to allostasis, injury, repair, and rehabilitation. Relevant basic science, clinical, and theoretical studies were selected and synthesized thematically. Evidence indicates that the initial tissue response involves activation of the neuroendocrine and immune systems, with controlled inflammation and vascular redistribution prioritizing survival and repair. Immune polarization, neuroendocrine regulation, and behavioral adaptations subsequently coordinate the transition from inflammation to regeneration. Progressive mechanical loading acts as a controlled stressor, stimulating collagen synthesis, angiogenesis, and neuromuscular reorganization, provided that allostatic load remains within adaptive capacity. Conversely, excessive or chronic stressors—including inadequate recovery, poor sleep, or psychological distress—may increase allostatic load and contribute to maladaptive outcomes such as delayed healing, recurrent injuries, or chronic pain. Framing rehabilitation within an allostatic paradigm highlights recovery as a process of systemic reorganization toward a new functional equilibrium. This perspective provides clinicians and practitioners with a conceptual and practical framework to design individualized, integrative, and sustainable rehabilitation strategies.

Cite this article as: Valverde, D. R., & Migthy, D. C. (2026). Adaptive return-to-performance systems model: an allostatic framework for readaptation and recovery. Research in Sports Science, 16, 0100, doi: 10.5152/rss.2026.25100.