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Concussion Guidelines – Part 3

Concussion Guidelines – Part 3

Returning to Sport

Today, I will briefly cover the protocol for return to sport following a concussion. Typically this consists of six stages[1][2]:

  1. Recovery (no activity)
  2. Light aerobic activity
  3. Moderate activity (limited head/limb movement)
  4. Heavy non-contact activity
  5. Practice & full contact
  6. Competition

A bar graph of the first five stages for graduated return to sport can be seen below:

Screen Shot 2016-06-20 at 12.48.17 PM


As mentioned in the previous blog post (part 1 | part 2), the acute/recovery stage following a concussion involves complete physical and cognitive rest to allow the brain to heal. This stage may last 1-2 weeks. If the athlete does not experience concussion symptoms for greater than 24 hours and is medically cleared, light activity can begin.

The goal of the light aerobic activity stage is to increase heart rate. This may consist of light walking or the exercise bike for a duration of 5-10 minutes. There should be limited head and body movement with the associated activities and heart rate should be kept to <70%. Strength training (lifting weights) & sprinting would be contraindicated in this stage. If the athlete does not experience symptoms in the next 24 hrs, he/she can proceed to the moderate activity stage.

In the moderate activity stage, the goal is to slowly add head/limb movement and sport-specific movements. Head impact activities (such as heading a soccer ball) is still contraindicated. The athlete can participate in simple running drills, skating drills, soccer drills and etc for a duration of 30-45 minutes. If symptom-free over the next 24 hrs, the athlete can proceed to the heavy, non-contact stage.

In the heavy, non-contact stage, the athlete can begin their regular resistance/strength training program and participate in more complex drills that involve coordination and change in direction for a duration of up to 60 minutes. If the athlete is symptom-free following 24 hrs, reintegration into full contact practice can be done followed by return to sport if symptom-free.

If the athlete is experiencing symptoms following activity in any of the six stages, he/she will require further rest until they are asymptomatic for a minimum of 24 hrs! Going through and completing each stage may take several months or months depending on the individual. For optimal recovery – it is important to follow all the steps and to rest when necessary [2].

Author: Clarence Lau, BSc (Hons), MPhtySt

Toronto Registered Physiotherapist | Acupuncture Provider

Featured image from: http://concussionsontario.org/wp-content/uploads/2015/06/Concussion-WordmapCrop.jpg
[1] Consensus Statement on Concussion in Sport: the 3rd International Conference on Concussion in Sport held in Zurich (2008), Br J of Sports Med 2009; 43: i76-i84 doi:10.1136/bjsm.2009.058248
[2] Centers for Disease Control and Prevention, National Center for Injury Prevention and Control , Division of Unintentional Injury Prevention

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