If symptoms return during RTP, what must happen before reintroducing the protocol?

• A. At least 24 hours without symptoms
• B. Immediately restart from step 1
• C. Stop RTP permanently
• D. Seek emergency care

Answer: (A)

Return-to-play should be guided by symptoms and gradual progression. When symptoms reappear during the progression, the athlete must be kept out and not moved forward until they have been completely symptom-free for at least 24 hours. That 24-hour symptom-free period helps ensure true recovery and reduces the risk of another relapse or longer downtime. After meeting that 24-hour quiet period, you resume the protocol at the appropriate prior level where symptoms were not present, rather than forcing advancement or starting over from the beginning. This cautious approach balances safety with recovery, avoiding unnecessary delays while preventing pushing through symptoms. Emergency care is only needed if new red flags appear; none of the other options align with the need for a 24-hour symptom-free window before reintroducing progression.