Subsequent to written medical clearance stating that the student-athlete is asymptomatic at rest the Model Policy states that the graduated return-to-play protocol is initiated and supervised by a certified athletic trainer or school/team physician or, if not available, a regular physician or licensed health care provider trained in the evaluation and management of concussion. If symptoms re-occur during any step in the graduated return-to-play process the student athlete will return to the previous level on the following day.

Graduated return-to-play Protocol

  1. Complete one full day of normal cognitive activities without any re-emergence of symptoms. If no symptoms appear move to step 2 the following day.
  2. Light aerobic exercise. If no symptoms appear move to step 3 on the following day.
  3. Sport specific exercise – no head impact activities. If no symptoms appear move to step 4 on the following day.
  4. Non-contact training drills: progressive resistance training. If no symptoms appear move to step 5 on the following day.
  5. Full-contact practice and participation in normal training activities. In the Model Policy step 5 is initiated following medical clearance (This can be a verbal consultation with the student’s physician). If no symptoms appear move to step 6 on the following day.
  6. Return to play involving normal exertion or game activity.

Notes:
Cognitive activities encompass any activity where thought is involved. They include, but are not limited to: attending a full day of school, studying, watching practice, interacting with peers.

The student should continue to proceed to the next level if asymptomatic at the current level. Generally, each step should take 24 hours so that an athlete would take approximately 1 week to complete the protocol when symptoms do not re-occur. If any symptoms re-occur during the protocol, the student returns to the previous step after an additional 24 hours of rest and progresses accordingly.

If an athlete exhibits ANY re-emergence of signs or symptoms after returning to normal physical activity, he/she should be removed from activities and returned to a physician.