In the concussion return-to-play ladder, what is required before advancing to the next stage?

• A. Rest for 72 hours
• B. Being symptom-free for 24 hours
• C. Imaging
• D. Completing 5K run

Answer: (B)

Progress through the concussion return-to-play ladder is guided by how the brain handles exertion, not by a fixed time or a hard distance. The key requirement before moving to the next stage is being symptom-free for 24 hours. This ensures the brain has recovered enough that increasing activity won’t trigger a relapse. If symptoms come back at any stage, the athlete should revert to the previous, less demanding level and only advance again after remaining symptom-free for 24 hours.

Imaging isn’t used as a gate to progression; it’s not routinely needed to clear someone for the next stage unless there are red flags or persistent, concerning symptoms. And completing a set distance, like a 5K run, isn’t how readiness is determined—the focus is on gradual, symptom-free increases in activity.