A Standardised Clinical Protocol for Sub-Symptom-Threshold Aerobic Exercise Rehabilitation after Concussion (mild Traumatic Brain Injury)

This protocol standardises the assessment-led, exercise-prescription pathway for rehabilitation of concussion / mild traumatic brain injury, reflecting the shift established by the 6th International Consensus Statement on Concussion in Sport (Amsterdam, 2022) from prolonged rest to early, individually prescribed sub-symptom-threshold aerobic exercise as first-line treatment. It specifies: (1) screening for contraindications to graded exertion; (2) a standardised symptom-limited graded exercise test — Buffalo Concussion Treadmill Test (BCTT) or Bike Test (BCBT) — to derive an individual heart-rate threshold at symptom exacerbation; (3) conversion of that threshold into a sub-symptom-threshold aerobic prescription (target HR band, session structure, symptom-exacerbation stop rule); (4) progression governed by re-test data and heart-rate response rather than elapsed time, including the reduce-rather-than-rest response to a flare; (5) the graded return-to-sport/activity strategy and the two governing minimums (mandated stand-down and symptom-free period); and (6) documentation and scope-of-practice boundaries — diagnosis and medical clearance are reserved to the treating medical practitioner. The protocol is the clinical spine of the Concussion Rehab Mastery (CRM) course: eight modules, 480 minutes of assessed instructional content, referenced to a 136-item peer-reviewed evidence base. It is published to give accreditation bodies and clinicians a citable, reviewable standard of the method taught.