Wellness Wednesday: The Return-to-Play Protocol


Loudoun County, Va. — If you have participated in sports there is a good chance that you or one of your teammates has suffered from a concussion.

Concussion research is steadily growing and health clinicians are gaining more insight about the best practices for athletes who have sustained a concussion. While there are various factors to consider, evaluate, and manage, safely returning to sport should be taken seriously by the athlete, coaches, and parents.

Return-to-Play Protocol

Return-to-play (RTP) protocols take an athlete from stationary exercise, to full sport-specific execution before returning to the field or court. Each stage requires the athlete to be virtually symptom free before progressing to the next stage. The RTP protocol should only begin once the athlete is able to manage a full school day without a symptom flare up. This is necessary because if mental stimulation is a cause for concussion symptoms to surface or intensify, then we know that physical exertion will more often have a greater effect.

RTP Stages

Day 1 of the progression should consist of a stationary bike or a 10-15 minute walk at a moderate pace. Increased heart rate can produce symptoms at this stage, so any report of previous symptoms will keep the athlete on stage one until he or she can complete it symptom-free.

Day 2 will increase the intensity of exercise to light walk jog intervals, and body weight exercises in the vertical plane. This may include, lunges, squats, push-ups, high knees, etc.

Day 3 should involve more cardio exercises and multi-planar exercises. Consistent jogging for 15-20 minutes, jumping jacks, Russian twists, forward/side planks, side shuffles, mountain climbers are all appropriate.

Day 4 may begin the involvement of non-contact sport specific drills depending on the athlete’s current season. The session should be somewhat exhaustive lasting for about 45 minutes to an hour. Prior exercises done may be included with this. At this point, it may be okay to involve the athlete in a controlled practice with all coaching staff and teammates aware that all drills are non-contact for the returning athlete.

Day 5 is a full practice day. The athlete should be properly suited with helmet, mouth guard, and any other padding necessary for a full exertion practice. This is the last stage before full return to competition, and the athlete should not play in a game until he or she successfully completes this stage symptom free during and hours after practice.

Not all stages are progressed at the same speed. It’s normal for an athlete to go through a stage more than once, if it proves to be too taxing. While the goal is to get back to playing the game they love, there should be no outside pressure to get through the stage and downplay what they are feeling. It’s better to report any and ALL symptoms, even minor, so that the athletic trainer can make the best decision for the athlete in the long run.

Note: All return to play progressions should be done under the supervision and/or direction of a licensed medical professional, like an athletic trainer, physical therapist, or other discipline experienced with concussion management.

Do not attempt to complete this progression alone. This progression is not cookie cutter, but a general outline of what should happen during the athletes RTP protocol. Other exercises may be included, and time increased or decreased depending on the sport. Remember! When in doubt..wait it out!

NOTE FROM OUR SPONSOR: The physical therapists and athletic trainers at Loudoun Sports Therapy Center will work one on one with you to design a treatment plan that helps you meet your goals. Call us TODAY to speak to a member of our team: 703-450-4300.


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Loudoun Sports Therapy Center is a premier physical therapy clinic. We offer outpatient orthopedic and sports physical therapy as well as specialty programs.

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