A Graduated Return to Play (GRTP) programme incorporates a progressive exercise program that introduces a player back to contact training and play in a step wise fashion. Following a diagnosed concussion, the player should have physical and cognitive rest for at least 24 hours. Following this initial rest period, the player should be encouraged to become gradually and progressively more active whilst staying below their cognitive and physical symptom exacerbation thresholds.
If a player has symptoms prior to the concussive event, these must have returned to the pre-concussion level prior to commencing a GRTP.
For elite adult rugby players who are being monitored by experienced medical practitioners, each Stage of the GRTP should be for a minimum of 24 hours. The stages of the GRTP are shown in the table below.
World Rugby recommends that a medical practitioner or approved healthcare professional confirm that the player can take part in full contact training before entering Stage 5.
2017 RETURN TO PLAY RECOMMENDATIONS FOR ELITE ADULT PLAYER
- Each stage of the GRTP is for a minimum of 24 hours starting from the time of the injury.
- Players with symptoms present at 24 hours post injury, progress to Stage 2a. To be clear, if symptoms do not resolve within the Initial Rest (Stage 1) period then progression to symptom limited activities (Stage 2a) is recommended.
- Players who are symptom free following the Initial Rest (Stage 1) should progress to Stage 2b
- If any concussion-related symptoms occur during the stepwise approach, the athlete should drop back to the previous asymptomatic level and attempt to progress again after being free of concussion-related symptoms for a further 24-hour period at the lower level.
EACH STAGE IS A MINIMUM OF 24 HOURS
|Stage||Rehabilitation stage||Exercise allowed||Objective|
|1||Initial Rest (Physical and Cognitive)||Normal activites of daily living which do not worsen symptoms, vigorous activity should be avoided. Relative cognitive rest, limiting screen time etc- ensure symptoms continue to improve or remain absent. Symptoms must be absent before commencing Stage 2.||Recovery|
|2a||Symptom-limited activities||This includes activities of daily living that do not provoke symptoms. Consider time off or adaptation of work or study.||Return to normal activities (as symptoms permit)|
Light aerobic exercise
|Light jogging for 10-15 minutes, swimming or stationary cycling at low to moderate intensity. No resistance training. Symptom free during full 24-hour period.||Increase heart rate|
|3||Sport-specific exercise||Running drills. No head impact activities.||Add movement|
|4||Non-contact training drills||Progression to more complex training drills, e.g., passing drills. May start progressive resistance training.||Exercise, coordination, and cognitive load|
|5||Full contact practice||Following medical clearance, participate in normal training activities.||Restore confidence and assess functional skills by coaching staff|
|6||Return to sport||Normal game play.|