I am not talking about concussion protocol. THat should follow the accepted protocol that I. have discussed in the past . I am talking about the process of deciding when athletes are cleared to compete following a musculoskeletal injury that is not a life or limb threatening condition.
In professional sports the team has the final say. In high school sports the athlete and their parents have more say and the coach has less say. In college, especially with athletes who are on scholarship, the team has less say than in the pros and more than in high school. In addition to the medical information, there are other considerations, even though I think the medical people should have the last say.
In cases where there is clear evidence that participation is going to hurt the athlete, the medical input is usually sufficient. In less clear cut cases, where the likelihood of significant additional injury is less, there is more input from the athlete and coaches. Whether we like it or not, there are aspects of liability, gains to the school both in money and prestige, gains to the athlete (gaining or losing position in pro drafts for example), athletes desire to compete even with chance of further injury. These all go into the decision, and frequently do not involve the medical people other than to give their initial opinion.
We all know that there have been wrestlers competing with a variety of injuries, some of which require surgery to correct. I doubt that in all those cases the medical people have said that they recommend the athletes participate.