Key points
- The 6-Step Return to Play Progression is based on the International Concussion in Sport Guidelines.
- Parents and athletes should work closely with the team’s certified athletic trainer when available.
6-Step Return to Play Progression
After a concussion, an athlete should only return to sports practices with the approval and under the supervision of their healthcare provider. Each step typically takes a minimum of 24 hours. It is important for an athlete’s parent(s) and coach(es) to watch for concussion symptoms after each day’s return to sports progression activity.
An athlete should only move to the next step if they do not have any new symptoms at the current step. If an athlete’s symptoms come back or if he or she gets new symptoms, this is a sign that the athlete is pushing too hard. The athlete should stop these activities and the athlete’s medical provider should be contacted. After more rest and no concussion symptoms, the athlete can start at the previous step.1
Step 1: Back to regular activities
The athlete is back to their regular activities (such as school) and has the green-light from their healthcare provider to begin the return to sports progression. You can learn more about the steps to return to regular (non-sports) activities.
Step 2: Light aerobic activity
Begin with light aerobic exercise only to increase an athlete’s heart rate. This means about 5 to 10 minutes on an exercise bike, walking, or light jogging. No weight lifting at this point.
Step 3: Moderate activity
Continue with activities to increase an athlete’s heart rate with body or head movement. This includes moderate jogging, brief running, moderate-intensity stationary biking, moderate-intensity weightlifting (less time and/or less weight from their typical routine).
Step 4: Heavy, non-contact activity
Add heavy non-contact physical activity, such as sprinting/running, high-intensity stationary biking, regular weightlifting routine, non-contact sport-specific drills (in 3 planes of movement).
- Patricios JS, Schneider KJ, Dvorak J, et al. Consensus statement on concussion in sport: the 6th International Conference on Concussion in Sport–Amsterdam, October 2022British Journal of Sports Medicine 2023;57:695-711.