Non-Operative — Concussion Return-to-Sport

Massachusetts General Hospital · MGH Sports Medicine

Weight-Bearing

N/A — relative rest x 3 days; then sub-symptom threshold activity; no contact until Phase V

Key Restrictions

No complete rest beyond 72 hours (current literature); activities at sub-symptom threshold throughout; limit head movement and avoid Valsalva Phase II; no contact until Phase V; refer to concussion specialty clinic if not progressing as expected

Timeline & Phases

5 phases: Phase I (0-3 days, relative rest — household/community activities as tolerated), Phase II (Intermediate — light aerobic: biking/walking; limit head movement; goal 85% age-adjusted HR without symptoms), Phase III (Late — running/skating/swimming/footwork; increased head movement; cognitive demands: math, talking, plays while exercising), Phase IV (Transitional — sport-specific drills, passing/shooting, no contact), Phase V (Full RTS — scrimmage first, then game play if asymptomatic)

Notes

Revised 9/2021; active rehab replaces complete rest after 72 hours per current literature; sub-symptom threshold is the governing principle; formal exertional testing recommended — refer to specialist if unfamiliar; multidisciplinary team approach emphasized; concussion specialty clinic referral if not progressing. [Archived copy — original Massachusetts General Hospital URL retired in the Mass General Brigham site migration; Wayback snapshot 2025-04-25.]

Surgeon / Author

MGH Sports Medicine

Published

September 2021