TABLE 5

Graduated Return-to-Sport Program

StageAimActivityGoal of Step
1Symptom-limited activityDaily activities that do not provoke symptomsGradual reintroduction of work and/or school activities
2Light aerobic exerciseWalking or stationary cycling at slow-to-medium pace; no resistance trainingIncrease heart rate
3Sport-specific exerciseRunning or skating drills; no activities with risk of head impactAdd movement
4Noncontact training drillsHarder drills (eg, passing drills and team drills); may begin progressive resistance trainingExercise, coordination, and increased thinking during sport
5Full-contact practiceAfter medical clearance, participate in full, normal training activitiesRestore confidence and allow coaching staff to assess functional skills
6Return to sportNormal game playFull clearance/participation
  • Recommend 48 h of relative physical and cognitive rest before beginning the program. No more than 1 step should be completed per day. If any symptoms worsen during exercise, the athlete should return to the previous step. Consider prolonging and/or altering the return-to-sport program for any pediatric and/or adolescent patient with symptoms over 4 wk.