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Recommendations for a Safe Return to Sport and Physical Activity After COVID-19

Updated January 7, 2022

The following is a summary of return to sport guidance and best practices. Recommendation is to follow local and community prevalence. In agreement with American Academy of Pediatrics, we encourage opportunities for children and teens to participate in exercise and sport as soon as it is safe per health department and local authorities. Facilities, teams, coaches and families must acknowledge there are risks of return to sports during the continued COVID-19 pandemic.

The majority of COVID-19 infections occur during social contact and community spread, rather than active sport participation. We recommend following the state and local governing bodies with regards to their phased approach to social gatherings and physical distancing.

COVID-19 infection rates are consistent with community spread rates.

COVID-19 spread is less common non-contact sports when compared to contact sports.

COVID-19 spread is less common in outdoor sports when compared to indoor sports.

Face mask use during indoor sport decreases COVID-19 spread when compared to indoor sports without face masks.

If athletes, coaches, staff, officiates, school participants and spectators are feeling sick or ill, they should not attend practice or competition.

We recommend a phased approach or gradual return to sport in order to allow athletes to get back into shape, tolerate the heat and decrease their risk of injury.

Athletes, coaches, fans/spectators and officiates should undergo screening using symptom checklists and temperature check with a thermometer before each practice or competition. Asking if in the past 48 hours they have experienced:

  • Diarrhea, vomiting or nausea

  • Fever over 100.0

  • Headache

  • Muscle or body aches or fatigue

  • New loss of smell or taste

  • New or worsening cough

  • Runny nose or congestion

  • Shortness of breath or trouble breathing

  • Sore throat, different than your seasonal allergies

  • Do you have a household member or close contact who has been diagnosed with COVID-19 in the past 14 days?

  • Have you tested positive in the last 14 days or have a COVID-19 test pending?

General Recommendations

  • We recommend that coaches, staff, school participants and spectators wear masks or face protection at all indoor practices and games. How to wear a mask.

  • Masks should be worn by athletes when not participating, cannot maintain 3 feet of distance and in between drills/practice areas and may be considered while actively participating in their sport in outdoor sports.

  • Masks should not be worn for wrestling, gymnastics, cheerleading and swimming/dive/water sports where masks could be a potential hazard.

  • At minimum, thoroughly wash your hands with soap and water (minimum 20 seconds) OR use hand sanitizer before AND after practice or competition.

  • Clean and wipe down any equipment, before AND after practice or competition.

  • Do NOT share water bottles, equipment, towels, etc.

  • No team huddles, handshakes or fist bumps should take place.

  • Maintain physical distancing from teammates, coaches and other players when taking breaks and between games.

  • Allow for physical distancing in common areas including bathrooms, stands, sidelines, dugouts.

  • Slow return to sauna, hot tub/cold tub or pool use as cleaning and risk mitigation strategies can be implemented.

  • Cautious use of locker room and showers, only if physical distancing can be maintained and cleaning supplied are adequate.

  • Do not allow locker room, shower, sauna, hot tub/cold tub or pool use.

  • All machines and equipment MUST be properly cleaned before and after each individual use.

  • Limit the number of event sites based on local spread.

  • Discourage tournaments that cannot adhere to national, state or local directives on physical distancing, on and off the field of play. Check the area prior to travel to confirm quarantine status.

  • Do not share hotel rooms, meals or transportation with those outside your own household. 

If you have been diagnosed, suspect a COVID infection, have COVID symptoms, or had a presumed positive infection, please consult your physician prior to returning to sport.

Purpose: The purpose of this document is to promote the health of youth athletes, coaches and staff by providing recommendations for a safe return to sport and physical activity after the coronavirus, SARS-CoV2, “COVID-19” pandemic.

Given the changing environment, recommendations and guidelines may change at any time. This document has been most recently updated on January 7, 2022.

This document is a general information resource and should not be treated as medical advice to participate in any activity. These ideas are meant to supplement considerations by your state and local governing bodies and Health Department NOT meant to replace them. Rely on information at your own risk, consult the most up to date recommendations and your own state and local public health officials.  Speak with your physicians about any specific issues or questions that you may have.

Acknowledgement of infection risks


The decision to participate in sports and spectate at sporting events will be dependent on athletes, families, and sports clubs in concordance with rules and regulations from authorities. Participants and spectators should understand that social interaction and congregation increase the risk of individuals becoming ill from infection with SARS-CoV-2 and potentially spreading the virus to family members and the community.

While the rates of vaccinations are increasing, the risk of spread remains.  Please remember to wear masks, wash your hands and distance as much as possible, even if you or a family member has been vaccinated.  Follow health department and local school guidelines as well. 

If you have an underlying health condition, there may be an increased risk of participating in sports. Please contact your regular doctor before restarting your sports. Current known risk factors include increasing age, obesity with body mass index above 30, chronic lung disease including moderate, severe or uncontrolled asthma, type 2 diabetes, chronic kidney disease, sickle cell disease, heart conditions and the immunocompromised.

Benefit of sports and responsibilities of the athlete


The participation in sport has known health benefits, including promoting physical fitness and mental wellness.  Sports provide a social construct and interaction which is necessary in a time of uncertainty for our athletes. It is widely recognized that physical activity, performed for the right amount of time and intensity can provide benefits to the immune system. In addition, sports can provide a template for young athletes to learn concepts of teamwork, leadership, work ethic and integrity.

With these recognized benefits, we propose and recommend the following as schools, clubs and individuals consider returning to sport.

Athletes, families and participants in sports have a social and moral responsibility to report symptoms of COVID-19. Self-reporting all symptoms consistent with COVID-19 will not only decrease the spread but will also help keep athletes playing their sport. Coaches, administrators and parents should continue to encourage athletes to self-report any symptom.

Return to sports

All guidance, rules and regulations regarding the return of sports must be followed as set forth by the national, state, or local governments and health departments. All involved with making the decisions for return to sports should be up to date on government guidance and CDC recommendations.  All facilities, coaches, leagues and tournament directors should monitor recommendations and directives set forth by national, state and local levels.

A thoughtful approach to exercise gives athletes a chance to acclimatize to the temperature and the intensity/duration of practices. This slow ramp up of exercise can decrease the injury risk and heat illness, in particular if they have an extended time away from sport. 

In individuals where practices and competitions have potentially been decreased, or have had an extended time away from sport, there is increased risk of deconditioning, putting the athlete at much higher risk for injury if pushed too hard too fast. Overtraining, defined as prolonged or excessive repetitive activity/workouts in efforts to “catch up,” does not allow the body to adjust and recover, which can lead to decreased performance and/or increased risk injury.

Sports Physical/Pre-Participation Exam:  We encourage all athletes to see their pediatrician or primary care provider every year for a sports physical.  Please tell your pediatrician at your sports physical if you have been diagnosed with COVID-19 or had symptoms consistent with COVID-19 during the past year. We recommend discussing vaccination with your primary physician as well.

Should my child be vaccinated: We recommend all children eligible, currently ages 5 and older, to be vaccinated to help protect themselves and contacts who may not be able to be vaccinated. The currently available vaccine has been shown to be overall safe and very effective limiting COVID-19 risks and helping reduce transmission. Specific vaccine recommendations should be discussed with your provider. The only contraindication to the vaccine is previous severe allergic reaction (e.g., anaphylaxis) to a previous vaccine dose or to a vaccine component (e.g., PEG). The vaccine should also not be given for 90 days following treatment with a COVID-19 monoclonal antibody. Please visit our COVID-19 vaccine page for updated information.

Plan your pre-season


Do not attend OR participate in group/team sports or practice if:

  • You are feeling ill. Symptoms of the coronavirus can include fever (temperature of 100.0 as defined by the CDC), cough, difficulty breathing, and other symptoms as outlined by the CDC website.
  • If you have been exposed to COVID-19 based on the CDC recommendations.
  • If unsure about whether to attend or participate in practice due to possible symptoms OR exposure, it is recommended you contact your health care provider.

How should I get my child back into sport if they were exposed to COVID, symptomatic or COVID positive?

Between the National Federation of High Schools, CDC and the American Academy of Pediatrics, there are conflicting guidelinesIt is our position that each athlete, parent, or physician should weigh the options and the work up and evaluation should be individualized. All athletes who test positive for COVID-19 Infection should notify their pediatrician or primary care provider.  At least a phone or telemedicine visit is recommended for asymptomatic or mildly symptomatic athletes.  If the patient has prolonged symptoms, is at the elite level, older in age OR has any signs of difficulty in exercising, there should be an evaluation by a primary care physician or cardiologist. 

After COVID-19 infection, your child’s health care provider will help determine when it is safe to begin a graduated return to play progression based on your child’s medical history, symptoms, severity of illness and previous level of activityExercise during quarantine should be restricted while having symptomsExercise, once initiated, should be individualizedA graduated return to play progression will increase your child’s activity level and allow you to monitor any lingering symptoms of COVID-19 infection  

Please follow the American Academy of Pediatrics Return to Sport and Physical Activity, CDC guidelines and/or the National Federation High School recommendations.

The Missouri State High School Activities Association has provided this return to play form for athletes who tested positive for COVID-19.

AAP - COVID-19 Interim Guidance: Return to Sports and Physical Activity (aap.org) 

CDC –  Considerations for Youth Sports | CDC 

National Federation of High Schools - KSI Return to Sports and Exercise During COVID (PDF) 

Download a PDF of the Phasing Process for a Return to Sport guidelines.

Continue to follow local, county, state or national guidelines and recommendations.

Please review the recommendations from the Kansas State High School Activities Association (KSHSAA), Missouri State High School Activities Association (MSHAA) and National Federation of State High School Associations (NFHS) on how to participate safely.

We recommend going through a thoughtful, team-based approach when considering return to practice and competition.

  • Each individual athlete should make sure they have no symptoms.
  • At minimum, thoroughly wash your hands with soap and water (minimum 20 seconds) OR use hand sanitizer Before AND After practice or competition.
  • Clean and wipe down any equipment, Before AND After practice or competition.
  • Do NOT share water bottles, equipment, towels, etc.
  • Avoid touching your face or any object unless necessary and wash your hands after.
  • No high fives, fist bumps or chest bumps.
  • Maintain physical distancing from teammates, coaches and other players when taking breaks and between games.
  • Proper use of a face mask for all indoor sports training, competition, and on the sidelines is strongly recommended for people who are not fully vaccinated, except in the case where the mask bears a safety risk. 
  • Masks should be worn in public by unvaccinated persons, outside of sport, as directed by state or local government and what is currently recommended by the CDC.
  • Unvaccinated coaches, referees, umpires, staff and spectators should wear masks.
  • Masks should be considered while unvaccinated athletes are participating in their sport unless deemed a safety risk.
  • Masks should be worn when unvaccinated athletes are on the bench (during games) and when not participating in practice.

How to wear a mask.

  • Facilities, teams, and coaches must acknowledge there are increased risks of reopening sporting activities indoors to the participants, staff and fans.
  • Athletes, coaches, fans/spectators, and officiates should undergo screening using symptom checklists and temperature checks before each practice or competition.
  • We STRONGLY encourage a sign-in roster for spectators/athletes/coaches/officiates to allow for contact tracing.
  • Ensure there is space for physical distancing, plenty of soap/water, hand sanitizer and cleaning supplies.
  • Allow for physical distancing in common areas including bathrooms, stands, sidelines, benches, dugouts.
  • Consider posting signs in highly visible areas promoting common protective measures including physical distancing, cloth face coverings, and frequent and adequate hand and respiratory hygiene practices.
  • For locker room, shower, and pool use, we recommend limiting the number of people in each space to allow for physical distancing, clean the facilities in between each locker room or shower use and limit the amount of personnel in and out of facilities.
  • We do not recommend using hot tubs/cold tubs.
  • An indoor facility with proper ventilation, size and capacity of the building to allow for physical distancing is recommended, understanding the risk of transmission may be higher indoors relative to outdoors.
  • If practicing indoors, masks should be worn at all times by unvaccinated persons unless individuals can safely distance themselves and are actively participating.
  • Limit the number of event sites as to not spread resources thin and increase exposure risk.
  • Decisions regarding the timeline for reopening concession stands should follow recommendations stated by the local health department and governing bodies. Cleaning guidelines should be followed according to CDC recommendations and strong consideration for the elimination of cash services, self-serve drink and condiment stations should be made. Please be mindful to wear your mask when not actively eating or drinking.

If physical distancing can be maintained and local guidelines are followed, AND your school/event site allows spectators, we strongly recommend limiting the number of spectators at events. If your school/event/local government allows for spectators, universal masking in unvaccinated persons is recommended for all spectators present.

  • Ensure there is plenty of soap/water and hand sanitizer.
  • Consider a sign in roster for spectators, athletes, coaches and officials to allow for contact tracing.

Ensure all athletes, coaches, parents and spectators are properly washing their hands with soap and water OR using hand sanitizer.

Cleaning of surfaces, athletic training rooms, facilities etc. should follow the CDC recommendations for disinfecting community spaces.

Weight rooms

  • All machines MUST be properly cleaned before and after each individual use.
  • Limit the number of athletes based on the size and capacity of the room to allow for physical distancing and proper cleaning between athletes.
  • Remove and store non-essential equipment to minimize surface cleaning.

Athletic training rooms

  • Limit athletes based on size/capacity to allow for physical distancing and proper cleaning between athletes.
  • No use of cold/ice tubs for groups. HOWEVER if heat stroke/illness is a potential, an ice tub should be ready for treatment.
  • The use of heat packs, ultrasound, electronic stimulation units may be used once the facility has enough cleaning supplies for essential areas and individuals. Continue to clean in between each use.
  • Remove and store non-essential equipment to minimize surface cleaning.

Locker rooms

  • Discourage the use of showers and locker rooms unless physical distancing measures and adequate cleaning measures in between use can be met.
  • Can be used as bathroom facilities only if appropriate cleaning measures can be completed.
  • Remove and store non-essential equipment to minimize surface cleaning.

Portable toilets and/or bathroom facilities

  • Conduct consistent and frequent cleaning as outlined by CDC or facilities should be locked if unable to be sufficiently cleaned.
  • Adequate hand washing or sanitizer available and restocked on a regular interval. 

Equipment

  • Personal equipment should be cleaned with disinfectant before and after each use.
  • Avoid community equipment use when possible. If not possible, equipment should be cleaned before and after each individual use. An exception is ball use.
  • Ball sports - wipe down balls between drills, different users or have individual use ball availability if possible.
  • Water/drinks - Each athlete should have their own individual drink.  Encourage extra water options in case an athlete forgets their own water bottle.
  • Individual towel use only.
  • Singlets in wrestling should be washed or cleaned with an appropriate cleaning agent in between each match OR a secondary singlet be available.

Mouthguards

  • In the current phase of return to sport, no contact is recommended. As contact is not recommended, each individual athlete must weigh the risk of infection with the use of a mouthguard with the benefit of protecting against dental trauma. If athletes are in a position where dental trauma or contact can occur, continue to use their personal mouthguards during play with the appropriate safeguards.
  • Players should wear a mouthguard once activities restart, any time contact is possible.
  • Teams should review the use and safe handling of the mouthpieces with all players and staff.
  • Athletes should use their personal mouthguards. There should be NO sharing of mouthguards.
  • In between uses, athletes should wash or sanitize hands before and after removal of mouthguard.
  • Limit touching of the mouthpiece.
  • The mouthguard should be placed and stored in clean and safe area.
  • We recommend players have individual containers labeled into which they can place their mouthguard and not have it hanging on a helmet or out in the open.
  • Teams should designate an asst. coach/parent/volunteer to ensure the storage and handling is safe with labeled names and appropriate supplies for cleaning and storage available.
  • If the mouthguard is soiled, or a player is unsure if they have picked up another athletes' mouthguard, mouthpiece should be washed thoroughly with soap and water for minimum of 20 seconds. If this cannot be 100% assured, then the risk assessment for each individual must be continued with consideration of dental trauma as the risk of not wearing one.

We encourage tournaments and camps only if they can adhere to the national, state, or local directives on physical distancing, resources, and accommodations on and off the field. 

Encourage participants to not eat close to one another. Do not share transportation with those outside your household. Do not share hotel rooms or accommodations with other families and athletes outside of your household.

Monitor local and state rules on quarantine and travel restrictions prior to arrival. 

The occurrence of anxiety and depression has increasingly become more common among teens ages 12-17.  In 2003, the CDC showed that 5.4% of teens were diagnosed with anxiety and/or depression.  In 2011-12 those numbers had increased to 8.4% and it is estimated that those number are currently closer to 1 in 6 teens struggling with mental health.  

As athletes re-enter their worlds of school and sport, it is important for the adults around them to support a healthy adjustment to structured days and busy schedules.  Many athletes have high expectations for themselves and can become discouraged if situations such as play time or sports performance does not occur as they expect. 

We can support our athletes by giving them the opportunity to speak about and validate their experiences as they return to sports.   The following are some common warning signs of emotional distress:

  • Eating or sleeping too much or too little
  • Pulling away from people and things
  • Having low or no energy
  • Having unexplained aches and pains, such as constant stomachaches or headaches
  • Feeling helpless or hopeless
  • Excessive smoking, drinking, or using drugs, including prescription medications
  • Worrying a lot of the time; feeling guilty but not sure why
  • Thinking of hurting or killing yourself or someone else
  • Having difficulty readjusting to home or school life

If your student-athlete is exhibiting one or more of these signs, please respond to your concerns by seeking the available resources within your community.  Resources provided here.  

Frequently asked questions


If you want a vaccine, check with your local pediatric
ian/primary care physician or visit our COVID-19 vaccine page.

We recommend all children eligible, currently ages 5 and older, to be vaccinated to help protect themselves and contacts who may not be able to be vaccinated. The currently available vaccine has been shown to be overall safe and very effective limiting COVID-19 risks and helping reduce transmission. Specific vaccine recommendations should be discussed with your provider. The only contraindication to the vaccine is previous severe allergic reaction (e.g., anaphylaxis) to a previous vaccine dose or to a vaccine component (e.g., PEG). The vaccine should also not be given for 90 days following treatment with a COVID-19 monoclonal antibody. Children who have any symptoms or concerns after vaccination should discuss with their provider prior to continuing sports participation. Please visit our COVID-19 vaccine page for updated information.

Athletes who are vaccinated should still follow local ordinances when it comes to masking and distancing. Recommendations may change based on local preprevalence rates. Indoor and outdoor activities have minimal COVID risks in fully vaccinated athletes, but they can happen. If an athlete starts to have COVID-like symptoms, they should isolate and be evaluated prior to further participation. 

We encourage families to check state and local health department orders when considering travel. Check local and regional health department recommendations on travel restrictions or quarantine recommendations up on arrival. 

Do not share hotel rooms or accommodations with athletes or families outside of you own household. 

We do not recommend international travel at this time. 

Group practices, competitions and gatherings will be directed by the state and local government as well as individual school district policies. We recommend limiting exposure as much as possible. This includes only going to practice or competition when necessary as allowed by the state/local government. If you do go to practice or competition, we always recommend unvaccinated persons wearing a mask, maintaining physical distancing measures and having hand sanitizer available for personal use.

If you would like to get tested, please visit our COVID-19 testing page.

In efforts to continue to try and mitigate risk of transmission in activities that are at increased risk of transmission, i.e., sports, schools, clubs and leagues may consider requiring screening COVID-19 testing for participation.  

Screening testing can include student-athletes, coaches, parent volunteers, athletic trainers and any other individuals who may come into close contact with others during these activities. Testing frequency and timing may vary depending on the type and location of activity or sport.

Each individual athlete (and family) must weigh the risk of infection due to the mouthpiece versus the risk of dental trauma. If an individual currently decides to use a mouthpiece/guard or once contact is recommended it should be as follows:

  • Players would wear a mouthguard once activities restart, any time contact is possible
  • Teams should review this use and safe handling of the mouthpieces with all players and staff
  • Athletes should use their personal mouthguards. There should be NO sharing of mouthguards
  • In between uses, athletes should wash or sanitize hands before and after removal of mouthguard
  • The mouthguard should be placed and stored in clean and safe area.
  • We recommend players have individual containers labeled into which they can place their mouthguard and not have it hanging on a helmet or out in the open
  • Teams should designate an asst. coach/parent/volunteer to ensure the storage and handling is safe with labeled names and appropriate supplies for cleaning and storage available.
  • If the mouthguard is soiled, or a player is unsure if they have picked up another athlete's mouthguard, mouthpiece should be washed thoroughly with soap and water for minimum of 20 seconds. If this cannot be 100% assured, then the risk assessment for each individual must be continued with consideration of dental trauma as the risk of not wearing one.
Sports Medicine, Pediatric Orthopedic Surgery

Sports Medicine; Assistant Professor of Surgery, University of Missouri-Kansas City School of Medicine

Sports Medicine, Pediatric Orthopedic Surgery

Primary Care Sports Medicine and Non-Operative Pediatric Orthopaedics Physician; Pediatrician; Assistant Professor of Orthopaedic Surgery, University of Missouri-Kansas City School of Medicine

Pediatric Infectious Diseases

Associate Director, Pediatric Infectious Diseases Fellowship Program; Assistant Professor of Pediatrics, University of Missouri-Kansas City School of Medicine; Clinical Assistant Professor of Pediatrics, University of Kansas School of Medicine

Sports Medicine Outreach & Athletic Training Manager