When to Use

• Standard stepwise management for athletes returning to sport after a concussion.
• Follows the 2023 Amsterdam Consensus guidelines.
• Initiated after an initial 24–48 hour period of relative physical and cognitive rest.

Core Prerequisite

The 6 Stepwise Stages

1. 1Stage 1: Symptom-limited activity (ADLs, walking, light reading). Objective: Gradual re-introduction of activity.
2. 2Stage 2: Light aerobic exercise (Walking, stationary cycling; <70% max HR). No resistance training.
3. 3Stage 3: Sport-specific exercise (e.g., running drills, skating). No head impact/contact activity.
4. 4Stage 4: Non-contact training drills (Complex training drills, passing, resistance training).
5. 5Stage 5: Full-contact practice (Following medical clearance). Objective: Restore confidence and technical skills.
6. 6Stage 6: Return to play (Full participation in games/competition).

Advancement Rule

Allow at least 24 hours between each stage. If symptoms recur during a stage, the athlete should drop back to the previous successful stage and attempt to progress again after 24 hours of rest.

2023 Update: Early Aerobic Activity

The 6th Consensus (Amsterdam) emphasizes that "total rest" is no longer recommended. Controlled, symptom-limited physical activity (Stage 1/2) starting 24–48 hours post-injury has been shown to improve recovery times compared to strict inactivity.

Clinical Pearls

Clearance Protocol

1. 1Final Medical Clearance: Traditionally required before "Stage 5" (Full Contact).
2. 2Return-to-School Coordination: Ensure teachers and coaches are aligned on the athlete's current stage.

Related Tools

Standard Reference