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Updated: Jan 1, 2026
A Multi-Modal Approach to Assessing Recovery in Youth Athletes Following Concussion
Published on: September 25, 2014
Concussion Recovery Timeline of High School Athletes Using A Stepwise Return-to-Play Protocol: Age and Sex Effects
Kaori Tamura1, Troy Furutani1,2, Ross Oshiro1,2
1Department of Kinesiology and Rehabilitation Science, College of Education, University of Hawaii at Manoa, Honolulu.
Context:
Implementation of a stepwise return-to-play (RTP) protocol has become the standard management strategy for high school athletes to ensure a safe RTP after concussion. The detailed characteristics of the recovery timeline throughout the steps of an RTP protocol have not been delineated among the adolescent population.
Objective:
To investigate the days spent in each step of the stepwise RTP protocol in an adolescent population and examine the effects of age and sex on recovery time.
Design:
Cross-sectional study.
Setting:
Local schools.
Patients Or Other Participants:
Student-athletes from 57 schools.
Intervention(S):
A total of 726 patients with concussion (age = 15.5 ± 1.2 years, males = 454, females = 272) were included. The 7-step RTP protocol consists of the following steps: (1) complete cognitive rest, (2) full return to school, (3) light exercise, (4) running progression, (5) noncontact training drills and weight training, (6) full-contact practice or training, and (7) return to game play. The data were obtained by certified athletic trainers as a part of the statewide standardized concussion-management protocol.
Main Outcome Measure(S):
Days spent in steps 0 to 6 as well as a breakdown of days by sex and age.
Results:
The average total RTP days were 20.2 ± 13.9. Half of this time was spent in the return-to-school phase (steps 2-3: 10.2 ± 10.0 days). Compared with 17-year-old participants, younger participants (age = 14-16 years) took 3 or 4 days longer to start step 3 and to reach step 6 (P < .05). Females took longer to reach step 6 than males (21.6 ± 15.5 versus 19.3 ± 12.7 days) because they took longer to reach step 3 (14.7 ± 11.4 days) than males (13.0 ± 10.0 days; P < .05).
Conclusions:
Our study provides an estimated stepwise concussion recovery timeline for adolescent student-athletes. Clearance to start step 3 was the benchmark for the recovery timeline, as the duration of the exercise portion of the protocol was consistent across the age and sex groups.
