Rehabilitation stage | Functional exercise | Objective | Criteria to move to the next stage | |
0 | No physical activity | Symptom limited: physical rest | Recovery | To move to stage 1: no more symptoms |
1 | Walking | Walking for 15 continuous minutes once a day at low intensity [level three on the Pictorial Children’s Effort Rating Table (PCERT)]. No resistance training, weight lifting or activities risking collision or falls. | Initiate movement Level of physical activity: very, very easy to easy | To move to stage 2: No more symptoms If you have symptoms, go back to stage 0. Only progress when you have been asymptomatic for 24 hours. |
2 | Light aerobic exercise | Walking, swimming or stationary cycling keeping intensity to level 1, 2 or 3 of the PCERT. No resistance training. | Increase heart rate Level of physical activity: easy to just feeling a strain | To move to stage 3: No symptoms If you have symptoms, go back to stage 1. Only progress when you have been asymptomatic for 24 hours. |
3 | Higher intensity/sport-specific exercise | Skating drills in ice hockey, running drills in soccer. No activities risking collision or falls. | Increase movement Level of physical activity: starting to get hard to getting quite hard | To move to stage 4: No symptoms If you have symptoms, go back to stage 2. Only progress when you have been asymptomatic for 24 hours. |
4 | High-intensity exercise/non-contact training drills | Progression to more complex training drills, for example, passing drills in football and ice hockey. May start progressive resistance training. | Increase exercise and improve coordination The level of physical activity is hard to very hard | To move to stage 5: No symptoms and medical clearance is needed If you have symptoms, go back to stage 3. Only progress when you have been asymptomatic for 24 hours. |
Visit medical provider for clearance when asymptomatic at intensity level eight or higher, only progress to step five if medical clearance has been obtained and you are fully back at school | ||||
5 | Full-contact practice | Participate in normal training activities following medical clearance | Restore confidence and assess functional skills by coaching staff | To move to stage 5: No symptoms If you have symptoms, go back to stage 4. Only progress when you have been asymptomatic for 24 hours. Fully back to preinjury performance |
6 | Return to play | Normal game play |