Concussion Return to Play Protocol

Stage 1: Rest and energy conservation (at least 24 hours)

• Rest your brain and body (stop studying, working, and playing).
• Conserve your brain and body’s energy, it is needed to feel well and allow the brain to heal.

Stage 1:  Signature of completion (requires player & parent/guardian signatures)

I confirm that ________________ completed Stage 1 for a minimum of 24 hours with no symptoms on ___DD/MM/YYYY___.

___________________________

(Player Signature)

___________________________

(Parent/Guardian Signature)

Stage 2:  Light general exercise (at least 24 hours)

• Off-field activities.
• Begin with a warm-up (stretching/flexibility) for 5 – 10 minutes.
• Start a cardio workout for 15 – 20 minutes which can include:  stationary bike, elliptical, treadmill, fast-paced walking, light jogging, rowing or swimming (50% intensity).

Stage 2:  Signature of completion (requires player & parent/guardian signatures)

I confirm that ________________ completed Stage 2 for a minimum of 24 hours with no symptoms on ___DD/MM/YYYY___.

___________________________

(Player Signature)

___________________________

(Parent/Guardian Signature)

Stage 3:  General conditioning and ultimate specific skills work done individually (at least 24 hours)

• Off-field activities.
• Begin with a warm-up (stretching/flexibility) for 5 – 10 minutes
• Increase intensity and duration of cardio workout to 20 – 30 minutes
• Begin ultimate specific skill work:  running
• 50 – 60% intensity

Stage 3:  Signature of completion (requires player & parent/guardian signatures)

I confirm that ________________ completed Stage 3 for a minimum of 24 hours with no symptoms on ___DD/MM/YYYY___.

___________________________

 (Player Signature)

___________________________

(Parent/Guardian Signature)

Stage 4:  General conditioning and ultimate specific skills work done with a teammate (at least 24 hours)

• Can begin on-field activities.
• Increase duration up to 60 minutes.  Begin resistance training including neck and core strengthening exercises.
• Begin on-field warm-up
• Begin on-field practice of ultimate drills with a partner:  throwing, catching

Stage 4:  Signature of completion (requires player, parent/guardian & trainer signatures)

I confirm that ________________ completed Stage 4 for a minimum of 24 hours with no symptoms on ___DD/MM/YYYY___.

___________________________

(Player Signature)

___________________________

(Parent/Guardian Signature)

___________________________

(Trainer Signature)