Rothman Concussion Network


Graduated Return-to-Play Protocol

Monday, June 12th, 2017
Athletes move through a graded progression of increased activity while monitoring symptoms under the close supervision of a trained healthcare provider.
Graduated Return-to-Play Protocol

An athlete's return to school and sports should be a gradual process that is carefully managed and monitored by a trained healthcare provider. The latest concensus statement in concussion recommends that athletes complete a graduated return-to-play protocol prior to returning to contact sports in the event of a concussion. This protocol follows a five step process with the goal being to gradually increase activity while carefully moitoring symptoms at each step. This is to ensure that an athlete is healed completely prior to returning to any contact drills or sports. The graduated return-to-play protocol is typically overseen by a physical therapist, certified athletic trainer, or in some cases, coaching staff, under the direction of a physician.

An athlete should only move to the next step if they do not have any new symptoms at the current step.

Graduated-Return-to-Play Protocol


The athlete is back to their regular school activities, no longer experiencing symptoms from the injury when doing normal activities, and has been cleared by a healthcare provider to begin the return to play process.


Begin with light aerobic exercise only to increase an athlete's heart rate. This means about 5 to 10 minutes on an exercise bike, walking, or light jogging. No weightlifting at this point.


Continue with activities to increase an athlete's heart rate with body or head movement. This includes moderate jogging, brief running, moderate-intensity stationary biking, moderate-intensity weightlifting (less time and/or less weight than a typical routine).


Add heavy non-contact physical activity, such as sprinting/running, high-intensity stationary biking, regular weightlifting routine, non-contact sport-specific drills (in 3 planes of movement).


An athlete may return to practice and full contact (if appropriate for the sport) in controlled practice.


An athlete may return to competition.

For Your Brain The Best Minds

For Your Brain The Best Minds

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