A 14-year-old field hockey player with a concussion who is currently symptomatic—can she travel with her team to a tournament in two weeks but not participate in any games, and when is she allowed to return to play?

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Last updated: September 29, 2026 • View editorial policy

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It is not possible to determine when she can return to play at this visit

This 14-year-old field hockey player who is currently confused and symptomatic from her concussion cannot be cleared to play in the tournament in two weeks at this initial visit, and her return-to-play timeline must be individualized based on complete symptom resolution followed by a minimum 5-day stepwise progression protocol.

Why She Cannot Play in Two Weeks

Since she is currently symptomatic (confused), she must first become completely asymptomatic at rest before even beginning the return-to-play protocol 1. The evidence is clear: "A player should never return to play while symptomatic" 2.

Critical Timeline Considerations for Pediatric Athletes

  • Pediatric athletes take 7-10 days or longer to recover from concussion symptoms, which is significantly longer than college or professional athletes 1
  • Once asymptomatic, she requires a minimum of 5 days to complete the mandatory stepwise return-to-play protocol, with each step taking at least 24 hours 1
  • This means even in the best-case scenario (becoming asymptomatic immediately), she would need at least 5 days before full game participation

The Required Stepwise Protocol

The return-to-play progression mandated by guidelines 1 includes:

  1. Complete physical and cognitive rest (until asymptomatic)
  2. Light aerobic activity (walking, swimming, stationary cycling at 70% max heart rate)
  3. Sport-specific exercise (field hockey drills without head impact)
  4. Noncontact training drills (more complex drills, light resistance training)
  5. Full-contact practice (after medical clearance)
  6. Return to game play

If symptoms return at any stage, she must drop back to the previous level and wait 24 hours before attempting to progress again 2.

Why the Other Options Are Incorrect

  • "She may play in two weeks if scheduled": Impossible to predict at this visit since she's currently symptomatic
  • "She may play if exam is normal in one week": Violates the minimum 5-day stepwise protocol required after becoming asymptomatic
  • "She can play but only for 15 minutes": There is no "limited participation" option—athletes must complete the full protocol or not play at all 2, 1
  • "She may travel but not play": While potentially safer than playing, this option doesn't address the fundamental issue that her return timeline cannot be determined at this initial visit

Important Caveats

Under no circumstances should pediatric or adolescent athletes return to play the same day of their concussion 1. The phrase "When in doubt, sit them out!" is paramount 2, 1.

Additional Considerations

  • She requires cognitive rest as well, meaning reduced screen time and modified school workload 1, 3
  • Early light physical activity (like walking) can begin as soon as 2 days post-injury if tolerated, but this is not the same as return to sport 3
  • She needs medical clearance from a licensed healthcare provider trained in concussion management before returning to any contact activities 1

The most honest and medically appropriate answer is that it is impossible to determine her return-to-play timeline at this initial visit while she remains symptomatic. Her recovery must be monitored with serial evaluations, and she can only begin the stepwise protocol once completely asymptomatic at rest and with exertion 1.

References

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