Return to Play After a Concussion
Unfortunately concussions do occur and we need some guidelines in place in order to protect the athlete and make sure they truly are ready to return to activity. Before allowing those with concussions to return to sport, we must ensure they are symptom free for at least 24 hours. This is done by a symptom inventory and the patient must self report how they are feeling. It is incredibly important that the patient is honest with themselves, and the clinician at this time to make sure we truly are symptom free and not just anxious to return to activity.
As athletic trainers we do an activity progression that allows them to build back up to what level of activity they were at over the course of 5 days to allow us to ensure the brain has adequately recovered. Sometimes a patient might be symptom free but with the increased blood flow, increased breathing patterns they may see a return of their symptoms which would indicate to us that they are not ready to return to full activity. If at any point in time in the progression the patient has a return of symptoms they must return to a symptom free state for 24 hours and then can repeat the stage that they were unable to complete the last time. They won’t start the entire progression over from the beginning, but rather start where they left off. Also, more than one stage cannot be completed in a day. One stage = one day.
Day 1 – Once the patient has been symptom free for 24 hours we begin a light activity day, usually about 20 minutes of very light aerobic activity – think fast walking or extremely slow jogging, and then some body weight strengthening exercises, such as lunges, sit ups and push ups. Activity should last no longer than 30 minutes. If the patient has a return of symptoms at any point during this activity to stop the activity and be done for the day.
Day 2 is similar to day 1, but with increased intensity. The length of aerobic activity remain the same but the intensity will increase to increase the heart rate even further. They will also increase the repetitions of body weight exercises and can complete up to 15 minutes of light individual drills for their sport that do not risk head contact.
Day 3 is a return to non-contact practice. For some sports and activities this is where they essentially have completed the progression if their sport has a low contact risk, i.e. tennis, swimming, badminton, track running events. Again, this should remain non-contact and they should be able to stop if any symptoms do occur. For sports involving equipment they can wear their equipment, but still should not engage in any contact.
Day 4 is a return to contact practice. At this point in time they have completed the first 3 days symptom free and are able to start returning to activity.
Day 5 is a return to competition. Patient must have completed a full contact practice before they can return to full competition mode. Practice is a more controlled environment and can have less intensity so we are continuing to work on that build up to competition mode.
As always the patient needs to follow the guidelines of their physician they are working with. Some of these progression points can be changed or altered as a physician sees fit and always work under their guidelines and recommendations.