What governs progression through return-to-play stages after concussion?

• A. Symptom-free criteria and objective progression; symptom-guided progression.
• B. Clinician preference.
• C. Calendar time alone.
• D. Injury severity grade only.

Answer: (A)

Progression through return-to-play stages after concussion is driven by how the athlete feels and by objective signs of recovery. You move to the next stage only when there are no new or worsening symptoms at rest or with increasing levels of activity, and the athlete demonstrates tolerance to progressively harder activities using objective measures (such as balance performance, exertional tolerance, and cognitive function) without symptom provocation. If symptoms recur or worsen, you pause or step back and reassess before trying to advance again. This approach combines symptom status with measurable recovery, rather than relying on calendar time or injury severity alone.