Return to Play Guidelines

  • BasketballEffective July 2012, the Nebraska Concussion Awareness Act requires any athlete 19 years old or yonger reasonably suspected of having a concussion be evaluated by and have written authorization from an appropriate licensed healthcare provider (i.e. MD, DO, PA-C, APRN, neuropsychologist, athletic trainer), and written authorization from a parent prior to resuming activity following a concussion.
  • Symptoms of a concussion often resolve before neurocognitive brain function. Therefore, a concussed athlete may not be ready to return to play eventhough they may deny having symptoms and admit to feeling fine.
  • Neurocognitive evaluation is playing a greater role in determining Return to Play.  Increased use of neurocognitive testing is supported by the prevelance of commercial availability of computerized neurocognitive testing and its predecessor, pencil-paper testing.
  • It is the responsibility for a coach to disqualify any athlete from playing presenting with a note from anyone clearing them to play that remain symptomatic.

Return to Play Progression  (print this form) 

Return to Play protocol following a concussion should follow a stepwise process.  Step 1 represents the timeframe until post-concussion symptoms resolve completely (see Concussion Symptom Inventory Form/Sideline Assessment Tool).  This phase will vary considerably among individuals, and may be affected by age, prior history of head injury, injury severity, number of symptoms, and possibly gender among other clinical considerations.  Step 1 and the complete resolution of symptoms on average occur within 7-10 days, but may extend longer for others.  Progression to Step 2 of the Return Ti Play Progression can not occur until all post-concussion symptoms have resolved, and the student has returned to the classroom without modifications or accommodations being needed.

Progression to the next step and each step thereafter requires the athlete to remain symptom-free (asymptomatic). Generally, a minimum span of 24-48 hours should transpire between steps (after completing Step 2), with each exercise bout being at least 30 minutes or more in duration unless noted otherwise.  The athlete should be continually monitored for the return of any symptoms during exercise and afterwards.  If at any time an athlete experiences any post-concussion symptoms, they are to stop and rest until symptom-free once again for 24-48 hours before resuming the progression at the level when symptoms returned.                

1. Rest, No Exertional Activities until symptom-free (asymptomatic)
  • Physical & Cognitive (mental) Rest

2.  Light, Aerobic Activities

  • Walking, Biking; No weight lifting
  • Review Post-Concussion Symptom Checklist
    • following 10-20 minutes of light, exertional activity

3. Sport/Position/Event Specific Exercises & Drill 

  • Individualized, light - moderate conditioning/running drill, agility drills, light weight lifting; throwing, catching, kicking, shooting, passing, mat drills, conducted away from formal practices.
  • Continue to monitor Post-Concussion Symptoms (checklist)

4. Non-Contact practice 

  • Continue to monitor Post-Concussion Symptoms (checklist)
  • Inspect helmet; assure fit & properly functioning systems

5. Full-Contact practice 

  • Continue to monitor Post-Concussion Symptoms (checklist)

6. Competition 

  • Continue to monitor Post-Concussion Symptoms (checklist)


No athlete under the age of 19 should be allowed to return to play while presenting with any SYMPTOMS of a potential head injury (McCrory, 2008).

Everyone involved in playing sports – athletes, parents, and coaches should be relegated to RECOGNIZE signs and symptoms of a concussion head injury, while those responsible for the decision to return to play and managing concussed athletes should be left to appropriate licensed healthcare professionals with formal training and experience in managing sports concussions where doing so falls within their scope of practice and state licensure.


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