How to Return to Sports Following a Concussion

Updated September 2019

Concussions are no minor injury. A concussion is a mild traumatic brain injury that alters the function of the brain. They may occur from a direct blow to the head or indirectly when forces from another part of the body are transferred to the head and can result in a rapid or delayed onset of symptoms, typically within 24-28 hours. Unfortunately, common imaging techniques (x-ray, MRI, CT scan) are unable to detect concussions. So how can you identify one?

Concussions have a variety of symptoms, which may include:

Physical

• Headache

• “Pressure in the head”

• Neck pain

• Nausea or vomiting

• Dizziness

• Blurred vision

• Sensitivity to light or noise

Cognitive Symptoms

• Confusion

• Drowsiness

• Fatigue/low energy

• Difficulty remembering/concentrating

• “Don’t feel right”

• Feel like “in a fog”

• Feeling slowed down

Physical Signs

• Loss of consciousness

• Poor coordination/balance

• Poor concentration

• Slowness answering questions/following direction

• Vomiting

• Glazed eyes

• Slurred speech

• Personality/behaviour changes

Emotional Signs

• More emotional

• Sadness

• Irritability

• Nervous or anxious

What to do Immediately Following a Concussion

The most important first step to recovering from a concussion is relative rest! Both physical and cognitive activity can make concussion symptoms worse and delay recovery. Most people are able to carry on with light daily activities; however, some individuals will experience more severe symptoms and therefore need more rest. This may require the athlete to stay home from school/work, or only do half days until they are symptom free. Symptoms are often made worse by light, noise, and strenuous physical activity.

Minimize symptoms by:

• Wearing a hat/sunglasses when going outside or where there will be bright lights

• Using ear plugs in noisy environments

• Avoiding physical activity that aggravates symptoms

• Minimize screen time

• Recent evidence supports early engagement in light aerobic activity, this should not increase any of your current symptoms. Examples of light aerobic activity include stationary cycling and leisurely walking. This is monitored by an appropriate health care professional.

Concussion FAQ

1. How long do I have to wait until I can begin training again?

• An athlete should be completely asymptomatic for a full 24 hour period prior to engaging in the return to play protocol.

1. How long will each step in the return to play protocol take?

• Each step will take a minimum of 24 hours to complete.

• If the athlete has no recurring symptoms within 24 hours they may progress to the next level.

1. What if symptoms return during the return to play protocol?

• If the athlete experiences recurring symptoms at any level they must drop down to the previous level and they may continue through the protocol after a 24 hour rest period.

1. How long will it take to return to play?

• Most concussion resolve in 10-14 days.

• The recovery period is different with every athlete.

• Extra caution should be taken with youth. Remember “when in doubt, sit them out!”

Return to Play Protocol

Stage 1 - No Activity

Functional Exercise: Complete physical and cognitive rest

Objective of Stage: Recovery

Stage 2 - Light Aerobic Exercise

Functional Exercise: Walking, swimming, stationary cycling (<70% max HR), no resistance training

Objective of Stage: Increase heart rate

Stage 3 - Sport Specific Training

Functional Exercise: Skating drills in ice sports, running drills in field sports, no head impact activities

Objective of Stage: Add movement

Stage 4 - Non-Contact Training Drills

Functional Exercise: Progress to more complex training drills (e.g., passing drills)

Objective of Stage: Exercise, coordination, and cognitive load

Stage 5 - Full Contact Practice

Functional Exercise: Following medical clearance participate in normal training activities

Objective of Stage: Restore confidence and assess functional skills by coaching staff

Stage 6 - Return to Play

Functional Exercise: Normal game play

Objective of Stage: Return to play symptoms free

Who is Involved in the Return to Play Process

• A medical doctor should oversee the return to play process, preferably one with experience in concussion management.

• This ensures the safety of the athlete, as the doctor can monitor symptoms in the event that they are worsening.

• Others involved

• Coaches

• Therapist (physio/athletic)

• Parents

• Teammates

• Everyone should work together to ensure that the athlete make a full recovery prior to returning to play!

References:

McCrory P, et al. Br J Sports Med 2017;0:1–10. doi:10.1136/bjsports-2017-097699

Davis GA, et al. Br J Sports Med 2017;0:1–8. doi:10.1136/bjsports-2017-097506SCAT5

Jayme Gordon graduated from the University of British Columbia with a Master's degree in Physical Therapy. Prior to this she completed a Bachelor's of Science Kinesiology degree at the University of Victoria. She is a member of the Canadian Physiotherapy Association as well as the Physiotherapy Association of BC. Jayme has a passion for working with a diverse patient population ranging from athletes to community dwelling seniors. Book with Jayme today.