- A Guide to Safely Return Athletes 2 Play
- For Parents, Coaches, and Athletic Directors
What is a Concussion?
- A concussion is defined as a traumatically induced transient disturbance of brain function that involves a complex pathophysiological process. Typically, concussions occur during a bump, blow or hit to the head that causes the head and brain to move rapidly back and forth.
When Should I See a Medical Professional?
- Anybody that experiences any type of a hit to the head should consult with a sports medicine physician to be appropriately evaluated.
- 80-90% of concussions resolve spontaneously, with most older adolescents and adults returning to pre-injury levels of clinical function within 2 weeks; however, sometimes younger athletes can take up to 4 weeks for recovery.
- Sometimes, post-concussive symptoms can be complicated or prolonged and do not resolve spontaneously within these time frames - in these cases, seeing additional medical providers for collaborative care is likely necessary.
What Can a Physical Therapist Do to Help?
- Seek Physical Therapy if you are experiencing any of the following symptoms post-concussion:
- Impaired balance/gait
- Neck pain
- Difficulty focusing
- Exercise intolerance
- PTs are specially trained to address these symptoms, and help progress an athlete back to sport using a graded exposure rehab model.
Return to Sport
- Return to sport progressions are an important part of the rehab process in post-concussive syndrome. Before an athlete returns to sport, concussion-related signs and symptoms should be resolved.
- Continuing to play immediately following concussion increases risk for increased symptoms and prolonged recovery and places the athlete at risk for Second Impact Syndrome.
Return To Sport Stages Established by the CISG (Concussion in Sports Group)
- Stage 1 (24-48 hours post-injury): Symptom-limited activity → this stage typically includes initiating vestibular rehab and reintroducing normal daily activities with minimal symptom exacerbation
- Stage 2 (If asymptomatic for 24 hours after Stage 1): Light aerobic exercise → this includes light walking, stationary biking or other controlled activities that increase heart rate such as bodyweight exercise
- Stage 3 (if asymptomatic for 24 hours after Stage 2): Sport-specific exercise → this includes running, skating or other sport-specific aerobic exercise avoiding head impact; more intense bodyweight exercise
- Stage 4 (if asymptomatic for 24 hours after Stage 3): Non-contact training drills → sport-specific, non-contact training drills that involve increased coordination and thinking, in addition to progressive introduction of resistance training and plyometric/circuit training
- Stage 5 (if asymptomatic for 24 hours after Stage 4): Full-contact practice → assessment of psychological readiness and exit testing; return to normal training activities
- Stage 6 (if asymptomatic during stage 5): Return to Sport → full return to sport as long as athlete remains asymptomatic
State of Maryland Remove & Return to Play Guidelines
- Any student-athlete suspected of sustaining a concussion shall immediately be removed from practice or play.
- Each school shall use the graduated return to play protocols instituted in the Policies and Programs on Concussions for Public Schools and Youth Sport Programs.
- The student-athlete may not return to play until the student receives written clearance after receiving an appropriate medical assessment by one of the following:
- A licensed physician trained in the evaluation and management of concussions;
- A licensed physician’s assistant trained in the evaluation and management of concussions in collaboration with the physician assistant’s supervising physician or alternate supervising physician within the scope of the physician assistant’s Delegation Agreement approved by the Board of Physicians;
- A licensed nurse practitioner trained in the evaluation and management of concussions;
- A licensed psychologist with training in neuropsychology and in the evaluation and management of concussions; or
- A licensed athletic trainer trained in the evaluation and management of concussions, in collaboration with the athletic trainer’s supervising physician or alternate supervising physician and within the scope of the Evaluation and Treatment protocol approved by the Board of Physicians.
- To assist student-athletes, parents, and school personnel, to manage concussion events, each local school system shall provide to all involved persons:
- Written notification of possible head injury;
- Medical clearance forms for gradual return to sports participation following concussion; and
- Graduated return to play protocols