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Return to Play Progression Following Concussion


1. Once diagnosed with a concussion, a return to play progression will be started once the athlete has not had any symptoms for a 24 hour period and has seen the appropriate medical professional for assessment.

2. Return to play guidelines require the athlete to be symptom free for at least 7 days before returning to full participation.  

3. The following phases will be included in the post-concussion Return to Play rehab protocol.  It is recommended that this progression be supervised by an athletic trainer or physical therapist that specializes in concussion rehabilitation.  There should be a 24 hour period between each stage in which the athlete does not have an increase in symptoms.  If symptoms reoccur or increase, there should not be advancement to the next stage.  The athlete needs to wait until they are symptom free for another 24 hours before continuing with the progression.

Return to Play:   B-R-A-I-N

B – Bike

Light aerobic activity phase (10-20 minutes biking, <70% maximum heart rate):  Can try stationary biking for 10-20 minutes with the goal to increase your heart rate some but not necessarily break a sweat.  If no symptoms present during or after, proceed to the next step.  You should have completed the Return to Learn Protocol and be back at school full time without restrictions if performing this phase.

R – Run

Moderate aerobic activity phase:  Jogging intervals for 20-30 minutes with the goal of increasing your heart rate and breaking a sweat.  No weight lifting or resistance training.

A – Agility

Sport Specific Activity:  Work on passing, shooting, footwork with a ball on the soccer field.  60 minutes duration.  If no symptoms present during or after, proceed to the next step.  No contact and no heading.

I – In Another Color

Non-contact return to practice:  Return to a team setting without experiencing contact once you receive written authorization from an appropriate healthcare provider.  Wearing a different color jersey or penny will alert your teammates on your non-contact restriction.  During this phase, you can start heading training (contact Omaha Physical Therapy Institute for more information on heading training).

N – No Restrictions

Return to full contact practice:  Once 1-2 full contact practices are complete without recurrence of symptoms, then game play can commence.

*If you have any questions regarding the return to play protocol, return to learn protocol, or heading training please feel free to contact Omaha Physical Therapy Institute (OPTI) at 402-934-8688.

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Centers for Disease Control and PreventionNational Center for Injury Prevention and Control, Division of Unintentional Injury Prevention

Grool AM, Aglipay M, Momoli F, et al. Association Between Early Participation in Physical Activity Following Acute Concussion and Persistent Postconcussive Symptoms in Children and Adolescents. JAMA.2016;316(23):2504–2514. doi:10.1001/jama.2016.17396

May KH, Marshall DL, Burns TG, Popoli DM, Polikandriotis JA. Pediatric Sports Specific Return To Play Guidelines Following Concussion. International Journal of Sports Physical Therapy. 2014;9(2):242-255.