Concussion Series Part 2: Return to Play Protocol

In part 1, we discussed how people get concussions and what goes on in the brain that causes the symptoms. In part 2, we are going to talk about the process of returning to play.  The steps that are listed below should be followed by athletes that have been diagnosed with a sports-related concussion. This protocol was agreed upon at an international conference on sports-related concussion in 2016 and represents the latest consensus on the proper steps before returning to play. The link attached with the citation for the paper at the bottom of the page will take you to that consensus statement. Each step requires 24 hours of being symptom free before the athlete is allowed to move to the next step and should be managed by a qualified healthcare practitioner familiar with the current best practice guidelines.

  1. Reintroduction to daily activities such as school or work. 48 hours after initial injury can begin light easy aerobic exercise such as walking or riding a stationary bicycle as long as symptoms do not return.
    • Observe following guidelines when returning to school:
      • Begin reintroducing reading, texting, and screens (phone/TV) at increments of 15 minutes and slowly build up as symptoms allow.
      • Begin homework and reading at home to increase ability and stamina of cognitive functions.
      • Return to school part time or with breaks throughout the day.
      • Return to school full-time.
  1. If symptoms free with light aerobic activity for 24 hours athlete then can increase the aerobic activity to begin raising heart rate. Light jog or more intense riding on the stationary bicycle. No resistance training. Goal is to increase heart rate and if symptoms free can move to next step.
  2. After the increased aerobic activity athlete can begin to participate in sport specific skill training such as shooting drills, passing, and footwork. Individual position drills in football with no contact. No full team drills.
  3. Participate in full practice with no contact to begin reintroduction to sport.
  1. Participate fully in practice with no restrictions.
  2. Game play.

 

McCrory P, Meeuwisse W, Dvorak J, et al

Consensus statement on concussion in sport—the 5th international conference on concussion in sport held in Berlin, October 2016

Br J Sports Med 2017;51:838-847