Table 1 Graduated return to play protocol
Rehabilitation stageFunctional exercise at each stage of rehabilitationObjective of each stage
1. No activityComplete physical and cognitive restRecovery
2. Light aerobic exerciseWalking, swimming or stationary cycling keeping intensity <70% maximum predicted heart rateIncrease heart rate
No resistance training
3. Sport-specific exerciseSkating drills in ice hockey, running drills in soccer. No head impact activitiesAdd movement
4. Non-contact training drillsProgression to more complex training drills, eg passing drills in football and ice hockeyExercise, coordination, and cognitive load
May start progressive resistance training)
5. Full contact practiceFollowing medical clearance participate in normal training activitiesRestore confidence and assess functional skills by coaching staff
6. Return to playNormal game play