Table 1

Intervention protocol25

Rehabilitation stageFunctional exerciseObjectiveCriteria to move to next stage
0No physical activitySymptom-limited physical rest.Recovery—72 hours post injury.
1WalkingWalking for 15 continuous minutes once a day at low intensity(level 3 on Pictorial Children’s Effort Rating Table (PCERT)). No resistance training, weightlifting or activities risking collision or falls. Initiate movement.
Level of physical activity: very, very easy to easy.
To move to stage 2:
You have reached level 3 of PCERT.
2Light aerobic exerciseProgression of activities using one of following of your choice per day:
  • Type (eg, walking up and down stairs, jogging/running, swimming, stationary cycling).

No resistance training or activities risking collision or falls.
Increase heart-rate.
Level of physical activity: easy to just feeling a strain.
To move to stage 3:
You have reached level 4 of PCERT.
3Higher-intensity/sport-specific exerciseSkating 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 quite hard.
To move to stage 4:
You have reached level 6 of PCERT.
4High-intensity exercise/non-contact training drillsWhen sport-specific exercises well tolerated, progress to more complex training drills (eg, passing drills in football and ice hockey).
Maximum level 8 on PCERT.
May start progressive resistance training.
Increase exercise and improve coordination.
Level of physical activity: hard to very hard.
To move to stage 5:
You have reached level 8 of PCERT AND you have been cleared by doctor
Visit medical provider for clearance when asymptomatic at intensity level 8 or higher; progress to step 5 only if medical clearance obtained, and you are fully back at school.
5Full-contact practiceParticipate in normal training activities.Restore confidence and assess functional skills by coaching staff. To move to stage 6:
Fully back to pre-injury performance.
6Return to full competitionNormal game play.