Sports Medicine » Concussion Management Program

Concussion Management Program

Guidelines for Post-Concussion Return to Play


The Return to Activity Plan must be coordinated between the treating physician and the Athletic Trainer

We are now recognizing the importance of decreasing the amount of stimuli the brain must process following a concussion.  It is essential that a student athlete who has suffered a concussion “rest” his or her brain in the days following the injury.  It is especially important to avoid intense stimuli like loud noises and bright or flashing lights.  Thus, concussed student athletes should spend the days following a concussion staying away from activities such as attending sporting events, dances, and limit watching TV, playing video games, texting, or using the computer.  

Concussed student athletes with persistent symptoms, particularly symptoms worsened by auditory and/or visual stimuli, should be kept from returning to school or have a modified school schedule early on after a concussion.  The importance of cognitive rest must be stressed to the student athlete, parents and teachers.  

Post-Concussion Symptoms

In order to begin the Return to Activity Plan, the student athlete must have no post-concussion symptoms and passed the cognitive assessment and be cleared by a health care professional trained in concussion management.  

Post-concussion symptoms include:  


  Lack of energy, tiredness


  Dizziness, poor balance, lightheaded

  Difficulty concentrating

  Blurred vision

  Easily confused

  Sensitive to light and sounds

  Slowed thought processes

  Poor sleep

  Difficulty with memory

  Mood changes---irritable, anxious or tearful



Seven Steps to a Safe Return to Activity

Step 1.       Complete cognitive rest.  This may include staying home from school or limiting school hours and study for several days which would be determined by a physician or AHCT and supported by school administration.  Activities requiring concentration and attention may worsen symptoms and delay recovery.

Step 2.       Return to school full time.  

Steps 3.-7. Will be supervised by the high school AHCT.  (Each step is separated by a minimum of at least 24 hours.)  

Step 3.       Light exercise.  This step cannot begin until student athlete is cleared by the treating physician for further activity.  At this point, the student athlete may begin walking or riding a stationary bike.  

Step 4.       Running in the gym or on the field.  

Step 5.       Non-contact training drills in full equipment.  Weight training can begin.  

Step 6.       Full contact practice or training.  

Step 7.       Full competition (game or practice)

The student athlete may spend 1 to 2 days at each step before advancing to the next step.  If post-concussion signs or symptoms occur at any step, activity must stop.  

For more information go to:

This document was adapted from materials by Michael C. Koester, M.D., ATC, FAAP Chairperson, of Sports Medicine Advisory Committee, National Federation of High School Athletic Associations and ACTive program, available at