Return-to-Play Protocol

The return-to-play protocol is a structured, progressive series of activity levels used after a sport-related concussion. Each step takes at least 24 hours, and the athlete must remain symptom-free before advancing to the next step. If symptoms return, the athlete drops back to the previous step.

Step 1 — Symptom-limited activity

Light daily activities that do not provoke symptoms. Gradual reintroduction of school and screen time. Goal: gradual reintroduction of activity.

Step 2 — Light aerobic exercise

Walking, light stationary cycling. Heart rate less than 70% of maximum. No resistance training. Goal: increase heart rate safely.

Step 3 — Sport-specific exercise

Running or sport-specific drills without head impact risk. No contact drills. Goal: add movement and coordination.

Step 4 — Non-contact training drills

Harder training, progression to more complex drills. May start light resistance training. Goal: exercise, coordination, and increased thinking.

Step 5 — Full contact practice

Following medical clearance, participate in normal training activities including contact. Goal: restore confidence and assess functional skills.

Step 6 — Return to sport

Normal game play. Goal: return to play.

Important rules

• Each step must last a minimum of 24 hours
• If symptoms return at any step, drop back to the previous step
• Medical clearance is required before progressing to Step 5
• Full return-to-play typically takes at least 6 days if everything goes well — often longer
• Younger athletes and those with prior concussions typically progress more slowly

How HQ fits in

HQ Baseline captures objective cognitive, balance, and reaction time data that clinicians use to confirm an athlete has actually returned to their personal baseline before advancing through Steps 5 and 6. Symptom resolution alone is not enough — the objective data has to match.