What is the recommended treatment and return-to-play protocol for a teenager with a concussion?

Concussion Treatment and Return-to-Play Protocol for Teenagers

Teenagers with concussions must never return to play on the same day of injury and should follow a structured, stepwise return-to-play protocol that takes a minimum of 5 days once they are asymptomatic, with each stage lasting at least 24 hours. 1

Initial Management

• First 24-48 hours: Complete physical and cognitive rest is recommended 1, 2
• After 24-48 hours: Gradual return to cognitive and physical activities as tolerated 2
• Important: Prolonged complete rest beyond this initial period may be detrimental and could contribute to persistent symptoms 3

Treatment Approach

Cognitive Rest and Return to Learn

• Temporary school absence or modified classwork may be necessary 4
• Work with teachers and school administrators to modify academic workload to avoid symptom exacerbation 1
• Full return to school should be achieved before progressing to return to play 4

Physical Rest

• Avoid physical activities that risk symptom exacerbation
• Most concussion symptoms resolve within 7-10 days, though teenagers may take longer to recover than adults 1
• Recovery should be monitored by a healthcare professional experienced in concussion management

Return-to-Play Protocol

The following 6-stage protocol must be followed, with each stage lasting a minimum of 24 hours 1:

1. No activity: Complete physical and cognitive rest until asymptomatic
2. Light aerobic activity: Walking, swimming, or stationary cycling at 70% maximum heart rate; no resistance training
3. Sport-specific exercise: Sport-related drills with no head impact
4. Non-contact training drills: More complex drills; may start light resistance training
5. Full-contact practice: After medical clearance, participate in normal training
6. Return to play: Normal game play

Important Considerations:

• If symptoms return during any stage, the athlete must stop immediately
• Once asymptomatic for 24 hours, return to the previous asymptomatic level
• Medical clearance is required before advancing to stage 5 (full-contact practice) 1, 5
• The minimum time to complete the protocol is 5 days, assuming no setbacks 1

Special Considerations and Cautions

Medical Evaluation

• Any teenager with a concussion should be evaluated by a healthcare professional, ideally a physician with experience in concussion management 1, 5
• Neuroimaging (CT/MRI) is typically normal with concussion but may be indicated in certain cases 1

Warning Signs

• Teenagers typically have longer recovery periods than adults 1
• Some athletes may take weeks to months to recover completely 1
• Athletes with multiple concussions or prolonged symptoms may require a longer rehabilitation program 1

When to Consider Retirement from Sports

• Three concussions in one season
• Postconcussive symptoms lasting more than 3 months
• Consider referral to a concussion specialist if contemplating permanent removal from sports 1

Common Pitfalls to Avoid

• Returning too soon: Never allow return to play while still symptomatic, even if symptoms appear mild 1, 5, 4
• Same-day return: Under no circumstances should a teenager return to play on the same day of concussion 1
• Inadequate monitoring: Parents or athletic trainers should monitor progress through the protocol with proper guidance 1
• Excessive rest: Prolonged complete rest beyond 24-48 hours may contribute to persistent symptoms 2, 3
• Ignoring recurrent symptoms: If symptoms return during the protocol, this indicates incomplete recovery 1

Remember: "When in doubt, sit them out!" is the paramount principle in managing teenage concussions 1.