Table 1

Graduated return-to-sport (RTS) strategy

Stage Aim Activity Goal of each step
1Symptom-limited activityDaily activities that do not provoke symptomsGradual reintroduction of work/school activities
2Light aerobic exerciseWalking or stationary cycling at slow to medium pace. No resistance trainingIncrease heart rate
3Sport-specific exerciseRunning or skating drills. No head impact activitiesAdd movement
4Non-contact training drillsHarder training drills, eg, passing drills. May start progressive resistance trainingExercise, coordination and increased thinking
5Full contact practiceFollowing medical clearance, participate in normal training activitiesRestore confidence and assess functional skills by coaching staff
6Return to sportNormal game play
  • NOTE: An initial period of 24–48 hours of both relative physical rest and cognitive rest is recommended before beginning the RTS progression.

  • There should be at least 24 hours (or longer) for each step of the progression. If any symptoms worsen during exercise, the athlete should go back to the previous step. Resistance training should be added only in the later stages (stage 3 or 4 at the earliest). If symptoms are persistent (eg, more than 10–14 days in adults or more than 1 month in children), the athlete should be referred to a healthcare professional who is an expert in the management of concussion.