Safely returning to sport after a concussion
Concussions in Sports
A concussion is a brain injury caused by an impact or force to the head, face, neck, or body that causes the head and brain to accelerate and decelerate rapidly. This movement of the brain disrupts its normal function by overstretching the brain cells and causing injury to the brain tissue. This commonly leads to symptoms such as headache, dizziness, confusion, memory problems, balance issues, light or noise sensitivity, mood or sleep changes. Because concussions are functional brain injuries, they often cannot be seen on standard imaging (like X-rays, CT scans, or MRIs), but their effects can be serious, especially if you return to sport too soon.
Returning to sport too quickly after a concussion increases the risk of long-term brain injury if you were to sustain a second concussion before the first one is completely healed. Repeated concussions in close succession may lead to more severe or long-term brain injury, and is the proposed mechanism for the long-term impacts of contact sports such as chronic traumatic encephalopathy (CTE). That’s why a safe, gradual, structured, medically supervised return-to-sport plan is critical.
This is where Parachute Canada’s 6-step return-to-sport protocol comes in — a widely accepted, evidence-based approach to help ensure athletes recover fully before resuming full training or competition.
Parachute Canada’s 6-Step Return to Sport Protocol
Step 1: Symptom-limiting activity / Activities of daily living
Step 1 begins after a period of 24-48 hours of initial cognitive and physical rest
After the brief period of initial rest, we want to introduce some daily, non-strenuous activities in a safe environment, such as light walking, household tasks, or light school or work tasks.
In this stage, there is NO physical exertion, and your heart rate should not rise significantly from your resting heart rate.
Step 2: Light aerobic activity
Step 2 introduces some light cardiovascular activity, such as walking or stationary cycling at a slow to moderate pace.
The goal of this phase is to gently bring your heart rate above a resting level, but still keep the stimulus at a low level.
In step 2, there is NO resistance training or heavy lifting. We want to raise heart rate gently without risking head impact or exertional stress to the brain.
This is also the time to complete your Buffalo Concussion Treadmill Test with a trained healthcare provider to determine what heart rate you should be aiming for during exercise.
Step 3: Sport-specific exercise individually
Step 3 allows athletes to start doing sport-specific drills individually. This would include light conditioning training, working on specific skills, and getting your body prepped for return to practice.
There is still NO risk of a head injury, either inadvertent or accidental. Therefore, there is no drills that include other players, heading, body contact or high-speed changes. The aim is to reintroduce movement and motor patterns of your sport while still protecting your healing brain.
Step 4: Non-contact training and practice
Step 4 allows athletes to return to practice as a “red shirt”. This means they can participate fully in more challenging training drills, but are still not allowed to have any body contact.
This can now include drills with other players, more intense conditioning training, and you can add in some light resistance training.
The goal of step 4 is increased coordination, endurance, sport-specific skills and tolerance to increasing intensity of the physical and cognitive demands of full-speed sports.
Step 5: Full contact practice, return to low-risk sports
NOTE: YOU MUST GET MEDICAL CLEARANCE TO RETURN TO STEP 5. IT IS BEST PRACTICE TO COMPLETE THE GAPSKI-GOODMAN TEST PRIOR TO STAGE 5 IF PARTICIPATING IN A HIGH-RISK SPORT.
After medical clearance, step 5 allows athletes to begin full-contact practice or high-risk non-competitive sport activities, physical education, or drills that may involve body contact.
It also allows athletes to return to regular game play and competition in non-contact lower-risk sports (eg. volleyball, track and field, etc).
The goal of step 5 is to restore confidence, assess functional skills, and ensure the athlete tolerates contact without symptoms before returning to competitive play.
Step 6: Return to competitive contact sports
With medical clearance and the completion of all other stages, including full-contact practice without symptoms, the athlete can return to unrestricted, competitive, contact sports.
NOTE: This means that they have NO symptoms. No symptoms at work, school, at maximum physical exertion, with body contact, NO SYMPTOMS. PERIOD.
Key rules for safe progression:
You must stay at each step for a minimum of 24 hours. You cannot skip steps and you cannot do multiple steps in 1 day. Therefore, the absolute shortest time that you can safely return to full competition after a head injury is 7 days.
If any symptoms return after moving to the next stage, you must return to the previous stage, be symptom-free for at least 24 hours, and then you can try the next stage again.
Before advancing to full contact (step 5) or competition (step 6), a medical clearance letter from a physician or nurse practitioner is required in the Province of Ontario. In order to obtain that letter, it is best practice to either redo and pass your baseline concussion assessment or pass the Gapski-Goodman test.
For student-athletes, returning to full-time school (i.e. normal cognitive load) is strongly recommended before returning to full-contact sport.
The Role of Online Concussion Assessment and Management
For athletes in Ontario, our clinic offers online concussion assessment and management. This service can play a vital role in the early detection, diagnosis, and management of concussion. By integrating online assessment tools, athletes, coaches, schools, and healthcare providers can ensure:
Timely recognition of concussion symptoms.
Proper documentation of diagnosis (or ruling out concussion).
Coordination of care, clearance, and monitoring to support safe, evidence-based return to sport.
Using a standardized baseline and follow-up assessment that aligns with national best practice (as per Parachute Canada’s guidelines).
Incorporating an online assessment service makes adherence to protocols more accessible, especially in areas where in-person concussion specialists may be less readily available. You should not have to sacrifice good medical care and your long-term brain health because you cannot access high-quality healthcare after sustaining a concussion. To read more about our online concussion management service, please see our full blog detailing the process here.
If you are looking to book an appointment with a healthcare provider that is specifically trained in the assessment and management of concussions, either in person or virtually, you can access our online booking system for Back in Balance Clinic through the following link.