By Beth Jones, LAT, ATC

Why We Take It Slow: The Graduated Return-to-Play for Concussion

Hey coaches, parents, and athletic directors- I know how tough it can be to keep an athlete sidelined, especially when they’re begging to get back in the game. But when it comes to concussions, it’s crucial that we’re patient and put their long-term health first.

As an athletic trainer, I’ve seen firsthand what happens when an athlete returns too soon—it can lead to a longer recovery, more concussions, and in rare cases, life-threatening complications. That’s why we follow a graduated return-to-play protocol after an athlete is symptom-free. It’s not about being overly cautious- it’s about making sure they heal fully and safely.

Why Can’t They Just Play If They Feel Fine?

I get this question a lot. The problem is, just because symptoms go away doesn’t mean the brain is fully healed. A concussion is a brain injury, and the brain takes time to recover.

If an athlete returns to play before their brain is ready, they’re at higher risk for serious consequences, including:

  • Longer recovery – Studies show that athletes who return too soon are nearly twice as likely to have symptoms that last more than a month (McCrea et al., 2013).
  • More concussions – A young athlete who has sustained one concussion is three to six times more likely to suffer another one (Guskiewicz et al., 2003).
  • Second Impact Syndrome (SIS) – While rare, this condition, which causes rapid brain swelling and has a 50% fatality rate, can happen if an athlete suffers a second concussion before the first one has healed (Centers for Disease Control and Prevention, 2019).

We never want to take that risk. That’s why we take it slow.

The 5-Day Return-to-Play Plan

Once an athlete is completely symptom-free and cleared to start activity, we follow this step-by-step plan:

  1. Day 1: Light Activity – Easy walking or biking to get the heart rate slightly elevated.
  2. Day 2: Moderate Exercise – Light jogging or bodyweight exercises—nothing too intense.
  3. Day 3: Sport-Specific Drills – Non-contact skill work to ease back into movement.
  4. Day 4: Full-Contact Practice – Back to practice with controlled contact (if symptom-free).
  5. Day 5: Game Ready! – If everything goes well, the athlete is cleared for full play.

** One important rule: If symptoms come back at any stage, we stop and rest for 24 hours before trying the same step again. No exceptions!

What the Experts Say About Concussion Recovery

Still wondering why we take this approach? Here are some numbers that help put it into perspective:

  • High school athletes take longer to recover than college or pro athletes—on average, 7-10 days for symptom resolution, but longer if they return too soon (Meehan et al., 2010).
  • 69% of high school athletes with concussions played with symptoms before being diagnosed (Register-Mihalik et al., 2013). That’s risky behavior that could lead to serious consequences.
  • A study in Pediatrics found that student-athletes who waited at least 5 days before returning to play had shorter overall recovery times than those who tried to come back too soon (Thomas et al., 2018).

How You Can Help

Coaches, parents, and ADs—we need your support! Here’s how you can help keep athletes safe:

  • Trust the process. This isn’t just a random rule—it’s based on research and best practices from the CDC, NFHS, and National Athletic Trainers’ Association (NATA).
  • Watch for symptom hiding. 69% of athletes admit to hiding concussion symptoms because they don’t want to sit out (Register-Mihalik et al., 2013). We have to make sure their brain is fine, not just their attitude.
  • Know that doctor clearance isn’t the finish line. Clearance means they can start the return-to-play process- not that they’re automatically game-ready.
  • Remember: It’s about their future. A week off now is nothing compared to a lifetime of potential problems from repeated concussions.

At the end of the day, we all want the same thing—healthy, happy athletes who can play the sport they love for years to come. So next time an athlete (or coach, or parent) asks, “Can I play yet?” remind them: We’re not just thinking about this game—we’re thinking about their future.

If you ever have questions about concussion protocols, don’t hesitate to ask your athletic trainer. We’re here to help and keep your athletes safe!

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Sources

Thomas, D. G., Apps, J. N., Hoffmann, R. G., McCrea, M., & Hammeke, T. (2018). Benefits of strict rest after acute concussion: A randomized controlled trial. Pediatrics, 135(2), 213-223.

Centers for Disease Control and Prevention (CDC). (2019). Concussion in sports. Retrieved from www.cdc.gov

Guskiewicz, K. M., Marshall, S. W., Bailes, J., McCrea, M., Harding, H. P., Matthews, A., Mihalik, J. R., & Cantu, R. C. (2003). Association between recurrent concussion and late-life cognitive impairment in retired professional football players. Neurosurgery, 53(4), 733-744.

McCrea, M., Guskiewicz, K., Randolph, C., Barr, W. B., Hammeke, T. A., Marshall, S. W., & Kelly, J. P. (2013). Incidence, clinical course, and predictors of prolonged recovery time following sport-related concussion in high school and college athletes. Journal of the International Neuropsychological Society, 19(1), 22-33.

Meehan, W. P., d’Hemecourt, P., Collins, C. L., Taylor, A. M., & Comstock, R. D. (2010). Assessment and management of sport-related concussions in United States high schools. American Journal of Sports Medicine, 38(10), 2405-2409.

Register-Mihalik, J. K., Guskiewicz, K. M., McLeod, T. C. V., Linnan, L. A., Mueller, F. O., & Marshall, S. W. (2013). Knowledge, attitude, and concussion-reporting behaviors among high school athletes. Journal of Athletic Training, 48(5), 645-653.