Table 2

Control group protocol25

Rehabilitation stageFunctional exerciseObjectiveCriteria to move to next stage
0No physical activitySymptom-limited: physical rest.Recovery. To move to stage 1:
No more symptoms.
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:
No more symptoms.
If you have symptoms return to stage 0. Progress only when you have been asymptomatic for 24 hours.
2Light aerobic exerciseWalking, swimming or stationary cycling keeping intensity to level 1, 2 or 3 of 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 return to stage 1. Progress only when you have been asymptomatic for 24 hours.
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 getting quite hard.
To move to stage 4:
No symptoms.
If you have symptoms, return to stage 2. Progress only when you have been asymptomatic for 24 hours.
4High-intensity exercise/non-contact training drillsProgression to more complex training drills, for example, passing drills in football and ice hockey.
May start progressive resistance training.
Increase exercise and improve coordination.
Level of physical activity: hard to very hard.
To move to stage 5:
No symptoms; medical clearance needed.
If you have symptoms, return to stage 3. Progress only when you have been asymptomatic for 24 hours.
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 after medical clearance.Restore confidence and assess functional skills by coaching staff. To move to stage 5:
No symptoms.
If you have symptoms, return to stage 4. Progress only when you have been asymptomatic for 24 hours.
Fully back to pre-injury performance.
6Return to playNormal game play.