TABLE 3-8Graded Return-to-Play Protocol

StepRehabilitation StageFunctional Exercise at Each Stage of RehabilitationObjective of Each Stage
1No activityComplete cognitive and physical rest.Recovery
2Light aerobic exerciseWalking, swimming, or stationary cycling, keeping intensity <70% maximum predicted heart rate. No resistance training.Increase heart rate
3Sport-specific activitySkating drills in ice hockey, running drills in soccer. No head impact activities.Add movement
4Non-contact training drillsProgression to more complex training drills, e.g., passing drills in football and ice hockey. May start load progressive resistance training.Exercise, coordination, and cognitive
5Full contact practiceFollowing medical clearance, participate in normal training activities.Restore confidence and assess functional skills by coaching staff
6Return to playNormal game play. 

From: 3, Concussion Recognition, Diagnosis, and Acute Management

Cover of Sports-Related Concussions in Youth
Sports-Related Concussions in Youth: Improving the Science, Changing the Culture.
Committee on Sports-Related Concussions in Youth; Board on Children, Youth, and Families; Institute of Medicine; National Research Council; Graham R, Rivara FP, Ford MA, et al., editors.
Washington (DC): National Academies Press (US); 2014 Feb 4.
Copyright 2014 by the National Academy of Sciences. All rights reserved.

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