Describe a typical progression ladder for return-to-play after concussion.

• A. Rest until fully healed only; no progression.
• B. Symptom-free at rest, light aerobic activity, sport-specific non-contact drills, non-contact practice, full contact practice, return to competition; each stage symptom-free for 24 hours.
• C. Jump to full competition after 48 hours.
• D. Only rest for 2 weeks.

Answer: (B)

A staged, gradual return-to-play plan after concussion is designed to safely reintroduce activity only as the brain fully recovers, using objective checkpoints to prevent worsening of injury. The best approach starts with the patient being symptom-free at rest, then proceeds through progressively more demanding activities: first light aerobic exercise to restore cardiovascular fitness without head impact, then sport-specific non-contact drills to reintroduce technique and coordination, followed by non-contact practice, then full-contact practice, and finally return to competition. The key rule is that each stage must be completed with no symptoms for at least 24 hours before moving to the next, and if symptoms recur, the athlete should revert to the previous asymptomatic stage and only advance again once stable. This framework minimizes the risk of prolonged recovery, second-impact injury, and lingering deficits, while ensuring functional readiness for competition.

Resting until fully healed only and resting for a fixed period without gradual reintroduction are not practical strategies, as recovery varies and functional rehab is important. Jumping straight to full competition after a short period ignores the need for progressive loading and symptom monitoring. A rigid two-week rest with no staged activity also fails to account for individual variation and the benefits of supervised, gradual return.