Return to Play
When is it Safe to Return to Activity following a Concussion?
Anyone who sustain a concussion should undergo an evaluation by a qualified healthcare provider before returning to play. Athletes can return to play after they have completed a 5–6 step “Return to Play” program and have started a “Return to Academics” program. Athletes can return to play after they are completely free of all symptoms of a concussion and remain symptom free during and after physical testing.
It is difficult to determine if the brain has healed from a concussion; even after all symptoms have resolved, healing may not be complete. Neurocognitive testing can be a very helpful tool in determining brain function. With a comparison to a baseline test, this evaluation can be used in conjunction with a physician’s examination to reduce future risks.
Baseline testing collects data on an athlete’s cognitive and physical abilities prior to suffering the concussion. Baseline testing can include a neurocognitive evaluation (usually by computer) that tests multiple areas of brain function, including memory, problem solving, reaction times, and brain processing speeds. Symptom checklists, sideline assessment tools such as the Sideline Concussion Assessment Tool (SCAT-5), and balance testing are other examples of baseline evaluations that may be helpful.
Continuing to play immediately following concussion increases risk for increased symptoms and prolonged recovery and places the athlete at risk for Second Impact Syndrome.
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