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

Updated November 16, 2020

The following is a summary of return to sport guidance and best practices. Facilities, teams, coaches and families must acknowledge there are risks of return to winter, indoor sports during the continued COVID-19 pandemic.

Currently, multiple health departments have recommended against playing indoor sports. We recommend following the state and local governing bodies with regards to their phased approach to social gatherings and physical distancing.

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. How to wear a mask.

  • Masks should be worn by athletes when not participating and may be considered while actively participating in their sport.

  • 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.

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

  • 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 as to not spread resources thin and increase exposure risk.

  • Discourage tournaments that cannot adhere to national, state or local directives on physical distancing, on and off the field of play.

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 November 16, 2020.

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-2and potentially spreading the virus to family members and the community.

There is an elevated and quickly growing number of cases throughout the Kansas, Missouri and Kansas City Metro area, including in the adolescent population, which is concerning. The risk of spread increases with indoor sports, when unable to physically distance 6 feet or greater, with groups over 10 individuals including coaches, and if there are shared ventilation systems. With indoor sports like wrestling and basketball it is also hard to avoid breathing heavily in close contact with others, which is another increased risk.

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.

Phased return to sports


First and foremost, several local health departments and/or unified governments in the Kansas City Metro area have recommended to not play indoor sports at this time. There is an elevated number of cases throughout the Kansas, Missouri and Kansas City Metro area, including in the adolescent population, which is concerning. The risk of spread increases with indoor sports, when unable to physically distance 6 feet or greater, with groups over 10 individuals including coaches, and if there are shared ventilation systems. Since this is a recommendation rather than an order, there are several areas, organizations, districts and schools moving forward with indoor 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 who did not play fall or club sports, 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.

Plan your pre-season for post-pandemic


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 in the prior 14 days.
  • 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.

What are the risk levels of individual sports?


Based on the USOPC and modified by the National Federation of High School Sports guidelines, below are examples on what constitutes low, medium and high-risk sports:

Low-Risk Sports: Individual running events, cross country with staggered starts, golf, sideline cheerleading, weightlifting
Individual running events, cross country with staggered starts, golf, sideline cheerleading, weightlifting, bowling, fishing, swimming individual races, diving and bicycling
Moderate-Risk Sports: Basketball, volleyball, soccer, baseball, softball, field hockey, ice hockey, tennis, swimming relays, women’s lacrosse
Basketball, volleyball, soccer, baseball, softball, ice hockey, tennis, swimming relays and women’s lacrosse
High-Risk Sports: Football, wrestling, men’s lacrosse, competitive cheerleading, dance
Football, wrestling, men’s lacrosse, competitive cheerleading, dance, martial arts and field hockey

Some high- or moderate-risk sports can lower their risk in practice/competition if they are able to physically distance appropriately, limit or eliminate contact, wear masks and appropriately sanitize. Similarly, some sports may raise their risks if they are not able to physically distance appropriately, limit contact, wear masks and sanitize.

As we enter winter sports, including basketball and wrestling, there is inherit risk of transmission of COVID-19 with the transition to an indoor location for sports practices and games, and, competitions.

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.

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

View this flowchart to determine how and when it is safe for your child to return to sport. The Missouri State High School Activities Association has provided this return to play form for athletes who tested positive for COVID-19.

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 activity. A graduated return to play progression will increase your child’s activity level and allow you to monitor any lingering symptoms of COVID-19 infection. Your child may begin Phase 1 of the following return to play progression once he or she is able to complete activities of daily living (i.e. walking around the house, dressing, daily hygiene tasks, etc.) without worsening of symptoms and has been cleared by a health care provider for exercise or sports activities.

Throughout each phase, you should monitor your child for the following symptoms. If your child experiences any of these symptoms, discontinue activity and return to his or her healthcare provider for further evaluation.

  • Dizziness
  • Difficulty breathing
  • Chest pain/pressure
  • Decreased exercise tolerance
  • Fainting

Phase 1: At least two sessions of light aerobic activity (up to 70% maximum heart rate) for up to 15 minutes. Sessions should be at least 24 hours apart. Activities may include brisk walking, light jogging or using a stationary bike. No strength training.

Phase 2: At least one session of aerobic exercise (up to 80% maximum heart rate) for up to 30 minutes. Simple movement activities such as running drills may be added to increase level of difficulty. No strength training.

Phase 3: At least one session of exercise (up to 80% maximum heart rate) for up to 45 minutes. May add some simple sport specific activities and strength training to increase level of difficulty.  

Phase 4: At least two sessions of sport specific training (up to 80% maximum heart rate) for up to 60 minutes. Sessions must be at least 24 hours apart.

Phase 5: Resume normal training activities and duration for at least one session.

Phase 6: Return to competition with no restrictions.1

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

What can I do to allow my kid to play safely after a COVID infection from a heart perspective?

Cardiac Screening for Pediatric Athlete with Suspected or Confirmed COVID-19 Infection:

Algorithm for Return to Play After COVID-19 Infection: Athletes Who May Be Susceptible to Myocarditis

  • 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.
  • Masks MUST be worn in public, outside of sport, as directed by state or local government and what is currently recommended by the CDC.
  • Coaches, referees, umpires, staff and spectators MUST wear masks.
  • Masks should be considered while athletes are participating in their sport.
  • Masks should be worn when 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 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.

We recommend no spectators during practice/competition for indoor events due to the increased risk for potential spread of the virus.

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 is recommended for all spectators present.

  • Encourage temperature/symptom check before entrance into practice/games.
  • 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.

Discourage tournaments that cannot adhere to national, state, or local directives on physical distancing, on and off the field of play.

Consider single game elimination, no double headers, single game participation per night, duals or quads for wrestling as a way to decrease the amount of exposure and/or limit the number of teams allowed in the building/area of competition at a single time to avoid athletes congregating and to allow for appropriate physical distancing.

Discourage any overnight camps and limit day camp participants to allow for physical distancing. Phase in as directed and allowed by state/local government. Phase in the of participants as allowed by state/local government.

We encourage only local tournaments and camps currently based on CDC recommendations and current high rates of local community spread. Follow travel recommendations on CDC website.

Frequently asked questions

First and foremost, follow your local and state recommendations. Provided what we know now about COVID-19 and its transmission, indoor and contact sports have a higher risk for transmission and spread of the virus; this increases the risk that your athlete, parent, coach, referee may become infected with the virus and/or spread the virus to others.

Different sports and activities are thought to have different levels of risk involved in spread and infection. Below are the suggestions on the risk level associated with activity. 

Lowest Risk: Individual, skill-building drills or conditioning performed at home or with immediate family members. No sharing of equipment.

Moderate Risk: Individual or small group skill building drills or conditioning performed in small groups made of individuals other than immediate family members which still allow for adequate physical distancing. Equipment cannot be cleaned in between use.

High Risk: Activities involving close or frequent and/or sustained contact with multiple people who live outside the immediate family unit where virus particles can be easily transmitted. Activities that do not allow for appropriate physical distancing. 

Highest Risk: As with high risk above, adding in travel outside of the local area.

In short, we do not recommend traveling outside of your local area for the time being. As the states, region and nation open, these recommendations will slowly relax as well. Check state and local health department orders when considering travel. Currently, no international travel is recommended.

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 wearing a mask, maintaining physical distancing measures and having hand sanitizer available for personal use.

COVID-19 testing is currently limited in many regions due to many reasons. Currently, routine testing in asymptomatic athletes is not recommended. As testing becomes more available above-mentioned recommendations may change to reflect new recommendations made by national/state/and/or local government or health officials. If your child is exposed, has symptoms or has a positive test, please see this flowchart to determine how and when it is safe to return to 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.

We do recommend that coaches, staff and spectators wear masks or face protection. How to wear a mask.

Masks should be considered while athletes are actively participating in their sport if physical distancing is not possible. However, if safety concerns exist due to use of mask with participation, masks should not be mandatory during active participation as masks may be difficult for athletes to wear with participation in sport. We do not recommend masks with plastic face shields during sport  participation.

If an athlete is not actively participating in a drill or competition, it is recommended they wear a mask.

It is human nature to socially gather and sports are not different. As such, as the number of athletes allowed to gather in one place increases, and physical distancing recommendations remain, we recommend adequate adult supervision by coaches, staff or volunteers in order to encourage and remind athletes to physically distance.

Sports Medicine, Pediatric Orthopaedic Surgery

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

Sports Medicine, Pediatric Orthopaedics (Non-Surgical)

Pediatrician; Primary Care Sports Medicine and Non-Operative Pediatric Orthopaedics Physician; 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