*The patient must complete the full Return to Learn protocol before the Return to Play protocol can be initiated. The patient should not return to athletics until allowed to do so by a physician experienced in the management of concussion.  The return to athletics should be gradual, should be monitored by a physician, and should proceed in a step-wise fashion as outlined below. *The patient must be at each level for 24 hours without symptoms. *If any post-concussion symptoms occur, the patient should drop back to the previous asymptomatic level and try to progress again after another 24-hour period has passed.

Stage Activity Objective
1. No activity Symptom limited physical and cognitive rest. Recovery.
2. Light aerobic exercise Walking, swimming or stationary cycling keeping intensity <70% of maximum predicted heart rate.  No resistance training. Increase heart rate.
3. Sport-specific exercise Sport-specific exercise such as running drills.  No head impact activities. Add movement.
4. Non-contact training drills Progression to more complex training drills.  May start progressive resistance training. Exercise, coordination and cognitive load.
5. Full-contact practice Following medical clearance, participate in normal training activities. Restore confidence and assess of functional skills by coaching staff.
6. Return to play Normal game play. Full return to play.

Source: Adapted from Consensus Statement on Concussion in Sport 4th International Conference on Concussion in Sport held in Zurich, November 2012.

Return to Play Specialized Therapists






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