RETURN TO PLAY

In order to resume activity, the student-athlete must be symptom free and off any pain control or headache medications that they were not taking prior to the concussion. The athlete should be carrying a full academic load without any significant accommodations for 1-2 days. Finally, the athlete must have written medical clearance from an appropriate health care provider.

The program described below is a guideline for returning concussed student-athletes when they are symptom free. Student-athletes with multiple concussions and athletes with prolonged symptoms often require a prolonged or different return to activity program and should be managed by a physician that has experience in treating concussion.

The following program allows for one step per 24 hours. The program allows for a gradual increase in heart rate/physical exertion, coordination, and then allows contact. If symptoms return, the athlete should stop activity and notify their healthcare provider before progressing to the next level.

• STAGE ONE: Daily activities that do not increase symptoms (gradual reintroduction of school, work and walking).
• STAGE TWO: Light aerobic exercise: slow to medium pace jogging, stationary cycling. No resistance training. No increase in symptoms.  This stage allows for increased heart rate - begin with <55% of max HR, but if tolerating, can progress to <70% of max HR.
• STAGE THREE: Sport-specific exercise: moderate to higher intensity running or skating drills, but no activities with risk of head impact. This allows for increased heart rate and agility/movement.

STAGES 4-6 should only begin after the resolution of any symptoms, abnormalities in cognitive function, and any other clinical finding related to the current concussion, including during and after physical exertion.

• STAGE FOUR: Non-contact training: Higher intensity aerobic fitness, and non-contact/non-collision team training drills (e.g., passing drills). May begin progressive resistance training. This increases coordination and thinking during sport.
• STAGE FIVE: Full contact practice. Written medical clearance is required to resume contact or high-risk activity, allowing the athlete to participate fully in normal training activities. This restores confidence and allows coaches to assess functional skills.
• STAGE SIX: Full clearance / Normal game play.