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Return-To-Play

Returning to sport activities after a concussion can be challenging.

While rest in the early stages is essential, a structured and progressive Return-to-Play approach is critical to ensure a safe recovery. Athletes should be supported to rebuild activity gradually, beginning with symptom-limited movement and progressing through non-contact, sport-specific training before full return. As no two concussions are the same, athletes, families, coaches, and healthcare professionals must work together to monitor symptoms, follow medical guidance, and ensure a safe, confident return to play.

Why is it not always clear when it’s safe to return to sport?

Concussion symptoms can interfere with both physical capability and mental sharpness in sport. Athletes may experience reduced coordination, stamina, and balance, alongside slower reactions and impaired judgement. Recognising these effects is essential so coaches, medical professionals, and families can adjust training demands and support a safe, measured return to sport.

  • Return-to-Play Checklist

    ✔️ No symptom provocation at rest or with exertion when you feel ready to return. 

    ✔️ Adhere to any sport‑specific stand‑down periods (often up to 21–30 days in non‑elite settings). 

    ✔️ Obtain medical clearance from your GP before any full-contact practice or competition.

    ✔️ If symptoms emerge or worsen at any point back off on what phase you are, take 24 hours off, and return to the stage below. 

    ✔️ Track symptoms on a 0–10 scale; if they increase by ≥2 points, take 24 hours of relative rest and step back to the previous phase. 

    ✔️ Be honest with yourself and your healthcare team throughout your recovery. Returning too soon or sustaining a second impact before full recovery can significantly prolong healing and delay your return to sport or normal activities.

Return-to-Play Step Progression

01

First 24–48 hours

  • Prioritise rest and symptom‑limited activity
  • Engage in gentle activity like short, light walks
  • Avoid any activities that worsen symptoms
  • Have a responsible adult check in with you regularly and avoid driving, alcohol, or recreational drugs.
02

After the initial days, light aerobic activity.

Begin light, non‑contact aerobic exercise (e.g., stationary cycling, purposeful walking).

  • Start gently at ~40% of your maximum heart rate (HRmax ≈ 220 − age).
  • If symptoms do not worsen, build up over subsequent days to ~70% of HRmax.
  • If symptoms do not worsen, build up over subsequent days to ~70% of HRmax.
  • Keep resistance training light. Start with ~5 minutes and progress to 10–15 minutes if tolerated.
03

Progress to sport‑specific training (no contact)

  • If symptoms are improving and not worsening, add running, changes of direction, and sport‑specific movement patterns.
  • Continue to cap effort at ≤70% HRmax and stop if symptoms increase.
04

Higher‑intensity non‑contact training

  • Advance to heavier non‑contact efforts (e.g., intervals, high‑intensity cycling) and full training drills without any risk of head impact.
  • By the end of this phase, you should tolerate high‑intensity efforts across multiple days without symptom return.