The 6 Stages of Returning to Sport and Physical Activity Following a Concussion
Returning to sport after a concussion requires a careful, gradual approach to ensure athlete safety and prevent re-injury. The return-to-sport protocol follows six progressive stages, each designed to monitor symptoms and allow the brain to heal properly. Understanding these stages is essential for coaches, parents, athletes, and healthcare professionals managing concussion recovery.
What is a Return-to-Sport Protocol?
A return-to-sport protocol is a structured, step-by-step process that guides athletes safely back to full physical activity after sustaining a concussion. Each stage gradually increases physical exertion while monitoring for symptom recurrence. Athletes must be symptom-free at each stage before progressing to the next, ensuring the brain has adequate time to recover.
This protocol aligns with the 6th International Consensus Statement on Concussion in Sport, and Rowan’s Law in Ontario, emphasizing evidence-based concussion management and athlete safety.
The 6 Stages of Return to Sport After Concussion
Stage 1: Complete Rest and Recovery
Goal: Allow initial healing and symptom resolution
Activities: No physical or cognitive exertion that provokes symptoms
Duration: Typically 24-48 hours minimum
During this stage, athletes should avoid sports, physical education classes, screen time, and mentally demanding tasks. Rest is crucial for brain recovery. Once the athlete is symptom-free during daily activities, they can progress to Stage 2.
Stage 2: Light Aerobic Activity
Goal: Increase heart rate without risk of contact or head impact
Activities: Walking, stationary cycling, light jogging (5-10 minutes)
Intensity: Less than 70% maximum heart rate
Light aerobic exercise helps restore cardiovascular function without stressing the recovering brain. Athletes should perform these activities in a controlled environment and stop immediately if concussion symptoms return. If symptom-free for 24 hours, advance to Stage 3.
Stage 3: Sport-Specific Exercise
Goal: Add movement patterns specific to the athlete’s sport
Activities: Running drills, skating, sport-specific movements (no contact)
Intensity: Moderate intensity exercise
At this stage, athletes begin sport-specific training without any risk of head contact. Examples include shooting drills in hockey (without body checking), passing drills in soccer, or running routes in football. Symptoms must remain absent for 24 hours before moving forward.
Stage 4: Non-Contact Training Drills
Goal: Increase exercise intensity and cognitive load
Activities: Full practice participation without body contact or collisions
Intensity: Near-normal training intensity
Athletes rejoin team practices but avoid any contact situations. This stage tests coordination, cognitive function under pressure, and physical stamina. Coaches must ensure no contact occurs, and athletes should be monitored closely for symptom recurrence.
Stage 5: Full-Contact Practice
Goal: Restore confidence and assess readiness for game situations
Activities: Normal practice with full contact allowed
Requirement: Medical clearance required before this stage
Before returning to contact practice, athletes must receive clearance from a qualified healthcare professional—typically a physician or nurse practitioner. This stage confirms the athlete can handle the physical demands and contact inherent in their sport without symptom return.
Stage 6: Return to Competition
Goal: Full return to sport and game play
Activities: Unrestricted participation in games and competitions
Requirement: Successful completion of Stage 5 without symptoms
Once the athlete completes full-contact practice without symptoms, they can return to competitive play. Ongoing monitoring remains important, as some athletes may experience delayed symptoms or be at higher risk for subsequent concussions.
Important Considerations for Safe Return to Sport
Symptom Monitoring is Critical
Athletes must be completely symptom-free at each stage before advancing. Common concussion symptoms include:
- Headache or pressure in the head
- Dizziness or balance problems
- Nausea or vomiting
- Sensitivity to light or noise
- Difficulty concentrating or remembering
- Fatigue or feeling slowed down
If symptoms return at any stage, the athlete must return to the previous stage and remain symptom-free for 24 hours before trying again.
Each Stage Takes at Least 24 Hours
Athletes should spend a minimum of 24 hours at each stage. This allows adequate time to assess symptom response. Some athletes may require longer at certain stages depending on symptom severity and individual recovery rates.
Medical Clearance is Mandatory
Before returning to contact practice (Stage 5) and competition (Stage 6), athletes must obtain written medical clearance from a physician or nurse practitioner. This ensures professional oversight and compliance with concussion safety regulations like Rowan’s Law.
Younger Athletes May Need Longer Recovery
Children and adolescents often require more conservative timelines due to developing brains. Healthcare providers may extend recovery periods or add additional monitoring for youth athletes.
How CONCUSSIONALERT Supports Safe Return to Sport
Managing the return-to-sport protocol requires coordination between coaches, parents, athletes, and healthcare professionals. CONCUSSIONALERT simplifies this process by providing:
- Real-time injury reporting and notifications to all stakeholders
- Secure documentation of each return-to-sport stage and symptom tracking
- Access to healthcare professionals including free virtual consultations with Registered Kinesiologists and Nurse Practitioners for medical clearance
- Compliance with Rowan’s Law and best practice guidelines
- Transferable athlete profiles that follow players across teams and seasons
By centralizing concussion management on one platform, CONCUSSIONALERT ensures no step is missed and athletes return to sport safely.
Conclusion
The six-stage return-to-sport protocol is the gold standard for concussion recovery, protecting athletes from premature return and reducing re-injury risk. By following this structured approach—complete rest, light aerobic activity, sport-specific exercise, non-contact drills, full-contact practice, and return to competition—coaches and parents can confidently guide athletes back to the sports they love.
Remember: When in doubt, sit them out. Concussion recovery should never be rushed, and proper medical oversight is essential for long-term athlete health and safety.