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Alexander Central School District

Athletics » Concussion Management Protocol

Concussion Management Protocol

Graduated return to sport strategy
Stage Aim Activity Goal of each step
1 Symptom-limited activity Daily activities that do not provoke symptoms Gradual reintroduction of work/school activities
2 Light aerobic exercise Walking or stationary cycling at slow to medium pace. No resistance training Increase heart rate
3 Sport-specific exercise Running or skating drills. No head impact activities Add movement
4 Non-contact training Drills Harder training drills, e.g., passing drills. May start progressive resistance training Exercise, coordination and increased thinking
5 Full contact practice Following medical clearance, participate in normal training activities Restore confidence and assess functional skills by coaching staff
6   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.