Paige Havens

Over the past few months we’ve talked about a handful of great concussion topics. Hopefully, by now, you know the signs and symptoms and what to do when you suspect a concussion.

We’ve talked about the importance of education and baseline testing and how to gauge how seriously your athletic association takes concussion awareness and prevention. This month, let’s shift our discussion to best practices and protocols related to safe return to play after a concussion. 

Many people don’t realize that there are defined steps necessary for a patient to follow that helps them achieve a safe return to physical activity, no matter their sport or recreation. It is not ok to simply jump back into the action once your symptoms fade. That goes for practice as well as games. After resting your brain for several weeks, it’s imperative that you give it a chance to ease back into full activity. Implementing a graduated exercise program that slowly increases intensity will help you and your doctor best gauge when your brain is ready to run at full speed again. 

Attempted physical activity should only begin when the athlete has had a period where they have experienced concussion symptoms. Full clearance from your health care provider at this point is critical. Once deemed symptom-free the athlete can then begin to work in tandem with their health care provider through these five gradual steps:

Step 1: Light Aerobic Activity

Athlete will begin with light aerobic exercise only to increase their heart rate. This means about 5 to 10 minutes on an exercise bike, walking, or light jogging. No weight lifting at this point.

If the athlete can successfully complete Step 1 without symptoms returning, it’s safe for them to progress to the next step. 

Step 2: Moderate Activity 

Athlete continues with activities to further increase their heart rate along with body or head movement. This includes moderate jogging, brief running, moderate-intensity stationary biking, moderate-intensity weightlifting (less time and/or less weight from their typical routine).

If no symptoms return, the athlete can move to Step 3.

Step 3: Heavy, Non-Contact Activity 

Athlete adds heavy non-contact physical activity, such as sprinting/running, high-intensity stationary biking, regular weightlifting routine, non-contact sport-specific drills (in 3 planes of movement).

If no symptoms return, it is safe to move on.



Step 4: Practice & Full Contact 

Athlete may return to practice and full contact (if appropriate for the sport) in a controlled practice environment.

Yet again, if no symptoms present, it is safe to progress to the final step.

Step 5: Competition 

Athlete returns to full intensity and competition.

Remember, this is a very gradual process. These steps should not be completed in one day, but instead over days, weeks, or months and under full supervision of your health care provider. You have to give your brain time to adjust. If at any time symptoms present along the progression, the athlete should stop activity and consult with their health care provider to determine whether to step back a phase or return to a state of rest for a bit. Even after athletes return to play, parents should be diligent to watch for any returning or new symptoms, which can be a sign that the athlete is pushing too hard and needs to be closely monitored.

Every athlete wants to get back to their sport quickly after injury, so it can be so tempting to rush the Return to Play process, but I assure you, in the long run, it’s well worth the wait to do this right!

You can contact Paige Havens by email: or call 678-938-4279