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MA DPH Post-Concussion Graduated Return to Play Protocol
MA DPH Post-Concussion Graduated Return to Play Protocol
After a student-athlete is diagnosed with a concussion by their primary care physician or neurologist and before returning to participation with their athletic program, the student-athlete must complete the 6-Stage Graduated Return to Play Protocol as described by the King Philip Student Concussion Policy and App A: Mass DPH Post Head Injury Form. The student-athlete should not be participating in any physical activity until they have been seen by their primary care physician or neurologist.
When symptom-free, the student-athlete will be asked to go to his/her physician to obtain clearance to begin the RTP activities. The only forms allowed to clear a student-athlete for the commencement of the RTP activities are either the Physician’s Head Injury Evaluation Communication Form, a Physician’s note on their organization’s letterhead providing the same information as the Communication Form, or the most recent copy of the Massachusetts Department of Public Health (MA DPH) Post Sports-Related Head Injury Medical Clearance and Authorization Form.
While the student-athlete is completing the RTP activities, the licensed athletic trainer will maintain all records regarding signs, symptoms, and progress. If during the RTP activities, the licensed athletic trainer and/or school nurse determine the student-athlete is not making appropriate progress, the licensed athletic trainer and/or school nurse should refer to the student’s primary care physician (or physician managing the case). In order for the student-athlete to return to participation after the completion of the RTP is the most recent copy of the MA DPH Post Sports-Related Head Injury Medical Clearance and Authorization Form.
Graduated Return to Play Protocol In Practice
Graduated Return to Play Protocol In Practice
When a student-athlete has been cleared to begin the Graduated Return to Play (RTP) Protocol, the athletic trainer will guide the student-athlete through the RTP. To program for the protocol, the athletic trainer will use guidance inspired by The International Journal of Sports Physical Therapy Pediatric Sports Specific Return to Play Guidelines Following Concussion to gradually reintroduce them into practice as quickly, but as safely, as possible. Here is a typical outline for the increase in activity level:
Stage 1: Low levels of physical activity – 15-minute HIIT on the exercise bike
Stage 2: Moderate levels of physical activity with body/head movement (Total Cumulative Activity Duration: 30 minutes)
Jogging at 50%-60% max pace 20-30 minutes
Calisthenics or Resistance Training Circuit Program of 3 sets of 3-5 different exercises
Stage 3: Heavy non-contact physical activity (Total Cumulative Activity Duration: 45 minutes)
Stage 4: Sports-specific practice (Total Cumulative Activity Duration: 60 minutes)
Stage 5: Full contact (if appropriate) in a controlled drill or practice.
Stage 6: Return to competition.
Part of this process includes the student-athlete providing the care team information after every practice or organized team activity from stage 2 to stage 5. The athlete must provide a detailed list with specific drills and exercises they may have completed, writing it as a bulleted list (see template below). Here is a list of details to include: Warm-Up Duration; Protective equipment worn, if applicable; Activity or Drill Names and Details (please be as detailed as possible); Weightlifting Exercise, Sets, and Repetitions; Team Conditioning Details; Self-Guided Conditioning Details.
Stage (number) – (Date) MM/DD/20YY
Equipment Worn (if applicable):
Warm-up Duration: (number) minutes
Sport-Specific Drills (if applicable, split by offensive & defense): (number) minutes total
Drill Name x (number) minutes
Team Weight Room (if applicable): (number) minutes total
Exercise, Sets x Reps
Team Conditioning (if applicable): (number) minutes total
Exercise, Sets x Reps
Self-Guided Conditioning (if applicable): (number) minutes total
Exercise, Sets x Reps
Comments:
Did the activity cause any symptoms:
How did you feel you did during activity:
Any additional comments:
Using the RTP Template
Using the RTP Template
Below are some good examples of what the activity list should look like for team-based sports. More information will be provided to individual-based sports like Track & Field, Gymnastics, and Swim & Dive.
Stage 2 Example - All Sports
Stage 2 Example - All Sports
Stage 2 – 09/06/2025
Self-Guided Conditioning: 30 minutes total
Jogging @ 60% of max pace x 25 minutes, ~ 2 miles
Push-ups 3 x 10
Body Weight Squat 3 x 10
High Plank Shoulder Taps 3 x 10 each side
Leg Lifts 3 x 10
Glute Bridges 3 x 10
Comments:
Did the activity cause any symptoms: No
How did you feel you did during activity: It felt good to get back into working out
Any additional comments: N/A
Other Calisthenics or Resistance Training Exercises:
Stage 3 Example - Football (Runningback / Linebacker)
Stage 3 Example - Football (Runningback / Linebacker)
Stage (number) – (Date) MM/DD/20YY
Equipment Worn (if applicable):
Warm-up Duration: (number) minutes
Sport-Specific Drills (if applicable, split by offensive & defense): (number) minutes total
Drill Name x (number) minutes
Team Weight Room (if applicable): (number) minutes total
Exercise, Sets x Reps
Team Conditioning (if applicable): (number) minutes total
Exercise, Sets x Reps
Self-Guided Conditioning (if applicable): (number) minutes total
Exercise, Sets x Reps
Comments:
Did the activity cause any symptoms:
How did you feel you did during activity:
Any additional comments:
Stage 3 Example - Soccer
Stage 3 Example - Soccer
Stage (number) – (Date) MM/DD/20YY
Equipment Worn (if applicable):
Warm-up Duration: (number) minutes
Sport-Specific Drills (if applicable, split by offensive & defense): (number) minutes total
Drill Name x (number) minutes
Team Weight Room (if applicable): (number) minutes total
Exercise, Sets x Reps
Team Conditioning (if applicable): (number) minutes total
Exercise, Sets x Reps
Self-Guided Conditioning (if applicable): (number) minutes total
Exercise, Sets x Reps
Comments:
Did the activity cause any symptoms:
How did you feel you did during activity:
Any additional comments:
Stage 3 Example - Volleyball
Stage 3 Example - Volleyball
Stage (number) – (Date) MM/DD/20YY
Equipment Worn (if applicable):
Warm-up Duration: (number) minutes
Sport-Specific Drills (if applicable, split by offensive & defense): (number) minutes total
Drill Name x (number) minutes
Team Weight Room (if applicable): (number) minutes total
Exercise, Sets x Reps
Team Conditioning (if applicable): (number) minutes total
Exercise, Sets x Reps
Self-Guided Conditioning (if applicable): (number) minutes total
Exercise, Sets x Reps
Comments:
Did the activity cause any symptoms:
How did you feel you did during activity:
Any additional comments:
Stage 3 Example - Basketball
Stage 3 Example - Basketball
Stage (number) – (Date) MM/DD/20YY
Equipment Worn (if applicable):
Warm-up Duration: (number) minutes
Sport-Specific Drills (if applicable, split by offensive & defense): (number) minutes total
Drill Name x (number) minutes
Team Weight Room (if applicable): (number) minutes total
Exercise, Sets x Reps
Team Conditioning (if applicable): (number) minutes total
Exercise, Sets x Reps
Self-Guided Conditioning (if applicable): (number) minutes total
Exercise, Sets x Reps
Comments:
Did the activity cause any symptoms:
How did you feel you did during activity:
Any additional comments:
Stage 3 Example - Hockey
Stage 3 Example - Hockey
Stage (number) – (Date) MM/DD/20YY
Equipment Worn (if applicable):
Warm-up Duration: (number) minutes
Sport-Specific Drills (if applicable, split by offensive & defense): (number) minutes total
Drill Name x (number) minutes
Team Weight Room (if applicable): (number) minutes total
Exercise, Sets x Reps
Team Conditioning (if applicable): (number) minutes total
Exercise, Sets x Reps
Self-Guided Conditioning (if applicable): (number) minutes total
Exercise, Sets x Reps
Comments:
Did the activity cause any symptoms:
How did you feel you did during activity:
Any additional comments:
Stage 3 Example - Lacrosse
Stage 3 Example - Lacrosse
Stage (number) – (Date) MM/DD/20YY
Equipment Worn (if applicable):
Warm-up Duration: (number) minutes
Sport-Specific Drills (if applicable, split by offensive & defense): (number) minutes total
Drill Name x (number) minutes
Team Weight Room (if applicable): (number) minutes total
Exercise, Sets x Reps
Team Conditioning (if applicable): (number) minutes total
Exercise, Sets x Reps
Self-Guided Conditioning (if applicable): (number) minutes total
Exercise, Sets x Reps
Comments:
Did the activity cause any symptoms:
How did you feel you did during activity:
Any additional comments:
Stage 4 Example - Football (Wide Receiver / Defensive Back)
Stage 4 Example - Football (Wide Receiver / Defensive Back)
Stage (number) – (Date) MM/DD/20YY
Equipment Worn (if applicable):
Warm-up Duration: (number) minutes
Sport-Specific Drills (if applicable, split by offensive & defense): (number) minutes total
Drill Name x (number) minutes
Team Weight Room (if applicable): (number) minutes total
Exercise, Sets x Reps
Team Conditioning (if applicable): (number) minutes total
Exercise, Sets x Reps
Self-Guided Conditioning (if applicable): (number) minutes total
Exercise, Sets x Reps
Comments:
Did the activity cause any symptoms:
How did you feel you did during activity:
Any additional comments:
Stage 4 Example - Field Hockey
Stage 4 Example - Field Hockey
Stage (number) – (Date) MM/DD/20YY
Equipment Worn (if applicable):
Warm-up Duration: (number) minutes
Sport-Specific Drills (if applicable, split by offensive & defense): (number) minutes total
Drill Name x (number) minutes
Team Weight Room (if applicable): (number) minutes total
Exercise, Sets x Reps
Team Conditioning (if applicable): (number) minutes total
Exercise, Sets x Reps
Self-Guided Conditioning (if applicable): (number) minutes total
Exercise, Sets x Reps
Comments:
Did the activity cause any symptoms:
How did you feel you did during activity:
Any additional comments:
Stage 4 Example - Basketball
Stage 4 Example - Basketball
Stage (number) – (Date) MM/DD/20YY
Equipment Worn (if applicable):
Warm-up Duration: (number) minutes
Sport-Specific Drills (if applicable, split by offensive & defense): (number) minutes total
Drill Name x (number) minutes
Team Weight Room (if applicable): (number) minutes total
Exercise, Sets x Reps
Team Conditioning (if applicable): (number) minutes total
Exercise, Sets x Reps
Self-Guided Conditioning (if applicable): (number) minutes total
Exercise, Sets x Reps
Comments:
Did the activity cause any symptoms:
How did you feel you did during activity:
Any additional comments:
Stage 4 Example - Wrestling
Stage 4 Example - Wrestling
Stage (number) – (Date) MM/DD/20YY
Equipment Worn (if applicable):
Warm-up Duration: (number) minutes
Sport-Specific Drills (if applicable, split by offensive & defense): (number) minutes total
Drill Name x (number) minutes
Team Weight Room (if applicable): (number) minutes total
Exercise, Sets x Reps
Team Conditioning (if applicable): (number) minutes total
Exercise, Sets x Reps
Self-Guided Conditioning (if applicable): (number) minutes total
Exercise, Sets x Reps
Comments:
Did the activity cause any symptoms:
How did you feel you did during activity:
Any additional comments:
Stage 4 Example - Lacrosse
Stage 4 Example - Lacrosse
Stage (number) – (Date) MM/DD/20YY
Equipment Worn (if applicable):
Warm-up Duration: (number) minutes
Sport-Specific Drills (if applicable, split by offensive & defense): (number) minutes total
Drill Name x (number) minutes
Team Weight Room (if applicable): (number) minutes total
Exercise, Sets x Reps
Team Conditioning (if applicable): (number) minutes total
Exercise, Sets x Reps
Self-Guided Conditioning (if applicable): (number) minutes total
Exercise, Sets x Reps
Comments:
Did the activity cause any symptoms:
How did you feel you did during activity:
Any additional comments:
Stage 4 Example - Baseball / Softball
Stage 4 Example - Baseball / Softball
Stage (number) – (Date) MM/DD/20YY
Equipment Worn (if applicable):
Warm-up Duration: (number) minutes
Sport-Specific Drills (if applicable, split by offensive & defense): (number) minutes total
Drill Name x (number) minutes
Team Weight Room (if applicable): (number) minutes total
Exercise, Sets x Reps
Team Conditioning (if applicable): (number) minutes total
Exercise, Sets x Reps
Self-Guided Conditioning (if applicable): (number) minutes total
Exercise, Sets x Reps
Comments:
Did the activity cause any symptoms:
How did you feel you did during activity:
Any additional comments:
Stage 5 Example -
Stage 5 Example -
Stage (number) – (Date) MM/DD/20YY
Equipment Worn (if applicable):
Warm-up Duration: (number) minutes
Sport-Specific Drills (if applicable, split by offensive & defense): (number) minutes total
Drill Name x (number) minutes
Team Weight Room (if applicable): (number) minutes total
Exercise, Sets x Reps
Team Conditioning (if applicable): (number) minutes total
Exercise, Sets x Reps
Self-Guided Conditioning (if applicable): (number) minutes total
Exercise, Sets x Reps
Comments:
Did the activity cause any symptoms:
How did you feel you did during activity:
Any additional comments:
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