Graded Return to Sport
Graded Return to Sport
The updated graded return to sport framework (GRTSF) below assists practitioners to guide athletes through the recovery process and return to sport. A collaborative multidisciplinary approach to concussion management with shared decision making is encouraged.
Concussion is an evolving injury and symptoms can change over time in one or more domains. All affected domains may not be evident during the early stages of the graded return.
Reintroduction of daily activities is appropriate if the activities do not severely exacerbate symptoms following the initial 24-48 hour period of rest. After the initial period of relative rest, graded return to school and/or work is advised.
Mild exacerbation of symptoms may occur during progression through the GRTSF. This is acceptable as long as the exacerbations are temporary, that is, the symptoms return to baseline before the next exercise session. Moderate or severe exacerbation of symptoms or symptoms that persist until the next scheduled bout of activity (considered prolonged symptoms) require further review by the Clinical Management Team (CMT).
The GRTSF requires those aged 18 or under to be symptom free for 14 days prior to medical clearance to return to contact or high-risk activity. To be clear, that is 14 days from when the athlete becomes symptom-free. This recommendation allows for the individual case variability in symptom duration. It ensures that the most vulnerable individuals have demonstrated a clear capacity to perform all normal activities of daily living, including non-contact exercise, without symptoms, before they return to the field of play.
The CLINICAL-GUIDELINES-FOR-FURTHER-REVIEW-POST-CONCUSSION.pdf outlines evidence-based assessment tools that can be used by the CMT to guide athlete management and rehabilitation. No single assessment tool exists for the diagnosis of concussion nor for the identification of symptom domains affected. Thus, clinical judgement of the CMT is vital in the rehabilitation and return to sport process.
Physiotherapists can use these GRTSF to inform their Return to sport patient programs.
- GRADED-RETURN-TO-SPORT-FRAMEWORK-COMMUNITY-AND-YOUTH.pdf
- Graded Return to Sport Framework in the Advanced Care Setting