Graduated return to play (GRTP) protocol

A graduated return to play (GRTP) protocol is a progressive exercise program that introduces an individual back to sport in a step wise fashion.

This should only be started when:

• symptom free at rest,
• returned to normal education or work, where appropriate,
• off treatments that may mask concussion symptoms, e.g. drugs for headaches or sleeping tablets.

The GRTP Protocol contains six distinct stages:

• Stage 1 is the recommended rest period
• The next four stages are restricted, training based activity
• Stage 6 is a return to play

Under the GRTP Protocol, the individual can advance to the next stage only if there are no symptoms of concussion at rest and at the level of physical activity achieved in the previous GRTP stage. If any symptoms occur while going through the GRTP program, the individual must return to the previous stage and attempt to progress again after a minimum 24-hour period of rest without symptoms. It is recommended that a medical practitioner or approved healthcare professional confirm that an individual can take part in full contact training before entering Stage 5.

Athletes with a history of two or more concussions within the past year are at greater risk of further brain injury and slower recovery and should seek medical attention from practitioners experienced in concussion management before returning to play

Any player with a second concussion within 12 months, a history of multiple concussions, players with unusual presentations or prolonged recovery should be assessed and managed by health care providers (multidisciplinary) with experience in sports-related concussions.