What are the guidelines for sports physical clearance in a 12-year-old with a history of concussion?

Sports Physical Clearance Guidelines for 12-Year-Olds with History of Concussion

Any 12-year-old athlete with a history of concussion must be completely asymptomatic at rest and with exertion, and receive medical clearance from a healthcare professional with experience in concussion management before returning to sports participation. 1

Assessment Before Clearance

• Medical evaluation must confirm:
  • Complete resolution of all concussion symptoms both at rest and with exertion
  • Normal neurological examination
  • Normal cognitive function
  • Successful completion of a stepwise return-to-play protocol

Return-to-Play Protocol

The American Academy of Pediatrics and the International Conference on Concussion in Sport recommend a structured, gradual return-to-play protocol with the following steps 2, 1:

1. No activity: Complete physical and cognitive rest until asymptomatic
2. Light aerobic exercise: Walking, swimming, or stationary cycling at low intensity
3. Sport-specific exercise: Running drills, skating drills (no head impact activities)
4. Non-contact training drills: More complex training and progressive resistance training
5. Full-contact practice: Only after medical clearance
6. Return to competition: Normal game play

Important Protocol Rules:

• Each step requires a minimum of 24 hours
• If symptoms recur at any step, the athlete must return to the previous asymptomatic level for at least 24 hours before attempting to progress again
• The recovery course is typically longer for younger athletes than for college and professional athletes, warranting a more conservative approach 2, 1

Special Considerations for Pediatric Athletes

• The signs and symptoms of concussion typically resolve in 7-10 days in most cases, but some athletes may take weeks to months to recover 2
• Pediatric and adolescent athletes should never return to play while symptomatic at rest or with exertion 2
• Athletes should never return to play on the same day of the concussion, even if they become asymptomatic 2, 1
• A more conservative approach to return to play is warranted for younger athletes 2

Multiple Concussion History

• For athletes with a history of multiple concussions or prolonged symptoms:
  • Consider referral to a specialist with expertise in sport-related concussion 2
  • Retirement from contact or collision sports may be necessary for athletes with a history of multiple concussions 2
  • Any athlete who has sustained 3 concussions in an individual season or has had postconcussive symptoms for more than 3 months should be strongly considered for a prolonged period away from sports 2

Common Pitfalls to Avoid

• Premature return to play: Returning an athlete to play before complete symptom resolution increases risk of prolonged symptoms and potential second-impact syndrome 1
• Inadequate monitoring: Athletes must be regularly monitored for symptom recurrence during the return-to-play progression 1
• Overlooking subtle symptoms: Symptoms of concussion can be subtle and may be overlooked by athletes, coaches/trainers, and parents 3
• Skipping steps in the protocol: Each step in the return-to-play protocol is essential and should not be skipped or accelerated 2, 1

The final return-to-play determination should occur only with documented medical clearance from a licensed healthcare provider who has been trained in the evaluation and management of concussions 4.