In a graded return-to-play progression after concussion, what is required at each step for progression?

• A. Proceed to the next step as soon as symptoms are mild
• B. Be symptom-free at each step for at least 24 hours and obtain clinician clearance
• C. Skip steps if the athlete desires
• D. Only the coach's approval is required

Answer: (B)

The idea behind a safe return-to-play progression after concussion is to move up only after the brain has clearly tolerated the previous level of activity. The requirement to be symptom-free at the current step for at least 24 hours and to have clinician clearance before advancing is what makes this approach protective. The 24-hour symptom-free window acts as a practical check that exertion at that level isn’t provoking lingering or rebound symptoms, indicating the brain is ready to handle more activity. Clinician clearance adds medical oversight, ensuring there are no hidden issues, and that recovery is progressing under professional guidance. This combination helps prevent returning too soon, which lowers the risk of a second concussion or longer recovery.