Getting Student Athletes Back in the Game After COVID-19

Laura Fralich, MD, FAAFP, CAQSM
Providence Orthopedics & Sports Medicine
Spokane, Wash.

Friday night lights won’t be as bright this high school football season. And several extracurricular sports and activities typically scheduled in fall are being postponed to winter.  To help ensure the safety of our children and student athletes, the Washington Interscholastic Activities Association, the governing body in the state of Washington, has modified the 2020-21 calendar to create four WIAA-sanctioned seasons. And while many students and parents may be frustrated with the change, this is in the best interest of the health of our youth and the wonderful communities who support them.

So, what are providers to do when a young patient tests positive for the COVID-19 virus, and when should the student be allowed back in the game?

In June 2020, the British Journal of Sports Medicine published recommendations in an infographic1 for returning athletes to sport after confirmed positive COVID-19 illness.  These recommendations have been endorsed by the American Medical Society for Sports Medicine and various other organizations in the United States, and provide physicians with a stepwise approach to helping patients safely return to physical activity and competition after COVID-19 illness.

Patients may begin this protocol after at least 10 days of rest and 7 days without symptoms and, at a minimum, should not experience fatigue or shortness of breath while walking at least 500 m (equivalent to 547 yards) or performing activities of daily living.

While we continue to learn more about the effects of COVID-19 on organ systems including the heart, lungs, and kidneys, this graduated return-to-play protocol recommends physicians consider lab work, EKG and/or echo, and pulmonary function testing in patients with comorbid conditions or prolonged symptoms.

For more information please visit the BJSM website at


  1. Elliott N, Martin R, Heron N, et al infographic. Graduated return to play guidance following COVID-19 infection: British Journal of Sports Medicine. Published Online First: 22 June 2020. doi: 10.1136/bjsports-2020-102637