{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T15:27:25Z","timestamp":1792682845552,"version":"4.5.0"},"reference-count":15,"publisher":"National Athletic Trainers' Association","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,1,1]]},"abstract":"<jats:sec><jats:title>Context<\/jats:title><jats:p>Implementation of a stepwise return-to-play (RTP) protocol has become the standard management strategy for high school athletes to ensure a safe RTP after concussion. The detailed characteristics of the recovery timeline throughout the steps of an RTP protocol have not been delineated among the adolescent population.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To investigate the days spent in each step of the stepwise RTP protocol in an adolescent population and examine the effects of age and sex on recovery time.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Cross-sectional study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Local schools.<\/jats:p><\/jats:sec><jats:sec><jats:title>Patients or Other Participants<\/jats:title><jats:p>Student-athletes from 57 schools.<\/jats:p><\/jats:sec><jats:sec><jats:title>Intervention(s)<\/jats:title><jats:p>A total of 726 patients with concussion (age = 15.5 \u00b1 1.2 years, males = 454, females = 272) were included. The 7-step RTP protocol consists of the following steps: (1) complete cognitive rest, (2) full return to school, (3) light exercise, (4) running progression, (5) noncontact training drills and weight training, (6) full-contact practice or training, and (7) return to game play. The data were obtained by certified athletic trainers as a part of the statewide standardized concussion-management protocol.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main Outcome Measure(s)<\/jats:title><jats:p>Days spent in steps 0 to 6 as well as a breakdown of days by sex and age.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The average total RTP days were 20.2 \u00b1 13.9. Half of this time was spent in the return-to-school phase (steps 2\u20133: 10.2 \u00b1 10.0 days). Compared with 17-year-old participants, younger participants (age = 14\u201316 years) took 3 or 4 days longer to start step 3 and to reach step 6 (P &amp;lt; .05). Females took longer to reach step 6 than males (21.6 \u00b1 15.5 versus 19.3 \u00b1 12.7 days) because they took longer to reach step 3 (14.7 \u00b1 11.4 days) than males (13.0 \u00b1 10.0 days; P &amp;lt; .05).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Our study provides an estimated stepwise concussion recovery timeline for adolescent student-athletes. Clearance to start step 3 was the benchmark for the recovery timeline, as the duration of the exercise portion of the protocol was consistent across the age and sex groups.<\/jats:p><\/jats:sec>","DOI":"10.4085\/1062-6050-452-18","type":"journal-article","created":{"date-parts":[[2019,12,26]],"date-time":"2019-12-26T15:43:51Z","timestamp":1577375031000},"page":"6-10","source":"Crossref","is-referenced-by-count":27,"title":["Concussion Recovery Timeline of High School Athletes Using A Stepwise Return-to-Play Protocol: Age and Sex Effects"],"prefix":"10.4085","volume":"55","author":[{"given":"Kaori","family":"Tamura","sequence":"first","affiliation":[{"name":"Department of Kinesiology and Rehabilitation Science, College of Education, University of Hawaii at Manoa, Honolulu"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Troy","family":"Furutani","sequence":"first","affiliation":[{"name":"Department of Kinesiology and Rehabilitation Science, College of Education, 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