Graduated return to play (GRTP)

Once the player is asymptomatic, they can begin a stepwise return to play. A number of sport-specific graduated return to play protocols exist and these increasingly differentiate between adult and age-group players (where a more conservative approach to return to play is recommended) and professional or community settings. Typically, these GRTP protocols have 6 levels; the player progresses each day to the next level if they are able to complete the current level without symptoms being provoked.

An adult elite player can theoretically move through the full protocol in one week if no symptoms are provoked. If any post-concussion symptoms recur while in the stepwise program, the patient should drop back to the previous asymptomatic level, be evaluated by a suitably qualified medical practitioner and try to progress again after a further 24-hour period of rest has passed. Medical clearance before resuming full contact training and/or playing is typically strongly recommended.

Neuropsychological tests may be used to objectively assess cognitive domains such as reduced attention and the ability to process information, slowed reaction times or impaired memory, and can help overcome a reliance on subjective symptoms when advising the concussed player on a safe return to play programme.