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Concussion Documentation

Graduated Return to Sport Strategy




Goal of each step


Symptom-limited activity

Daily activities that do not provoke symptoms

Gradual reintroduction of work/school activities


Light aerobic exercise

Walking or stationary cycling at slow to medium pace. No resistance training

Increase heart rate


Sport-specific exercise

Running or skating drills. No head impact activities

Add movement


Non-contact training Drills

Harder training drills, e.g., passing drills. May start progressive resistance training

Exercise, coordination and increased thinking


Full contact practice

Following medical clearance, participate in normal training activities

Restore confidence and assess functional skills by coaching staff



Return to sport

Normal game play



NOTE: An initial period of 24–48 hours of both relative physical rest and cognitive rest is recommended before beginning the RTS progression.
There should be at least 24 hours (or longer) for each step of the progression. If any symptoms worsen during exercise, the athlete should go back to the previous step. Resistance training should be added only in the later stages (stage 3 or 4 at the earliest). If symptoms are persistent (e.g., more than 10–14 days in adults or more than 1 month in children) the athlete should be referred to a health care professional who is an expert in the management of concussions.