New study shows that current return to play protocols could put athletes at risk

Oakville, ON – November 12, 2018 – A new Canadian study published in The Physician and Sportsmedicine shows that adding physical exertion tests to concussion protocols can prevent nearly 15 per cent of high-risk athletes from returning to sport too soon.1

The Gapski-Goodman Test (GGT) is a standardized physical exertion test that may help clinicians to determine if an athlete has achieved full recovery from a concussion. The GGT is designed to identify athletes who have not fully recovered despite completing standard return to play (RTP) protocols and are no longer reporting symptoms.1

“This study shows that making RTP decisions based on only symptoms could be inadequate,” says lead author, Dr. Cameron Marshall. “111 concussed athletes in the study – who had completed a standard protocol and were asymptomatic – demonstrated symptom recurrence during the test, potentially indicating incomplete recovery. As a result, these athletes were required to take the test again at a later date, which delayed their return, but more importantly, may have protected them from further injury.”

Athletes with a history of concussions are at higher risk for repeated brain injuries. Traumas in close proximity and before full recovery, can lead to prolonged symptoms, additional damage to the brain, and potentially, death.1 Therefore, an athlete should achieve full recovery before being cleared to return to sport.

The problem with relying on symptoms

Research shows that symptom recovery may be unreliable in determining readiness to safely return to sport. Metabolic and physiological time for recovery can often outlast symptom resolution.1

“Symptom reports are subjective and may not accurately reflect physiologic recovery,” says Carol DeMatteo, Professor, School of Rehabilitation Science of McMaster University. “The GGT results offer an objective measure to potentially hold an athlete back, which may reduce the risk for additional injury.”

Concussions are highly complex and individualized injuries that require appropriate RTP processes. Physiological measures of recovery may help to improve clinical decision-making for high-risk athletes.

For the complete study, visit:

About the Gapski-Goodman Test

The GGT was developed by the NHL Chicago Blackhawks medical staff, including Mike Gapski, Head Athletic Trainer, and Paul Goodman, Strength and Conditioning Coach. The test combines alternating aerobic and anaerobic states, and sport-specific vestibular and visual challenges designed to mimic a dynamic sporting environment. The GGT has been used as a final RTP test at the professional sport level for more than 5 years.

Physical Exertion Test

About the study

The study was completed by Complete Concussion Management Inc. (CCMI) in partnership with the School of Rehabilitation Science of McMaster University. Following typical RTP protocols, a total of 759 athletes underwent the GGT or modified GGT at partnered CCMI clinics as part of RTP decision-making. Although all athletes were asymptomatic and had completed standard concussion protocols for RTP, 14.6% of concussed athletes failed the GGT while attempting to achieve medical clearance to fully return to sport. Prospective data was collected electronically by trained CCMI clinicians utilizing the CCMI Concussion Database System.

About Complete Concussion Management Inc.

Complete Concussion Management Inc. (CCMI) is a Canadian organization with an international network of partnered clinics and licensed healthcare professionals with training in concussion management. Through evidence-based training programs and integrated healthcare technologies, CCMI empowers multidisciplinary teams to implement standardized care for those impacted by concussions. All partnered clinics are connected through the CCMI Concussion Database System, a proprietary electronic medical record system, which collects and securely stores concussion-related patient data and enables large-scale research to advance concussion management. For more information, visit


1 Cameron M Marshall, Nicole Chan, Pauline Tran & Carol DeMatteo (2018): The use of an intensive physical exertion test as a final return to play measure in concussed athletes: a prospective cohort, The Physician and Sportsmedicine, DOI: 10.1080/00913847.2018.1542258

Media Contact

Veronica McGuire
Media Relations
McMaster University, Faculty of Health Sciences
905-525-9140 x 22169

Rick Maddalena
Complete Concussion Management Inc.