What are the guidelines for clearing college athletes for sports after a concussion?

Guidelines for Clearing College Athletes for Sports Post-Concussion

College athletes with concussion must complete a stepwise return-to-play protocol and be completely asymptomatic at rest and with exertion before receiving medical clearance to return to sports. 1

Initial Management After Concussion

• When any college athlete shows ANY symptoms or signs of concussion, they must be immediately removed from play and not allowed to return to play in the current game or practice 1
• The athlete should not be left alone, and regular monitoring for deterioration is essential 1
• The athlete must receive a medical evaluation after the injury 1
• Neuroimaging (CT/MRI) is generally not indicated unless there is suspicion of a structural lesion (prolonged disturbance of consciousness, focal neurological deficit, seizure activity, or persistent symptoms) 1

Return-to-Play Protocol

The return-to-play protocol consists of six mandatory steps, with each step taking a minimum of 24 hours:

1. No activity: Complete physical and cognitive rest until asymptomatic 1
2. Light aerobic exercise: Walking, swimming, or stationary cycling at 70% maximum heart rate; no resistance training 1
3. Sport-specific exercise: Sport-specific drills without head impact 1
4. Non-contact training drills: More complex training drills, may start progressive resistance training 1
5. Full-contact practice: After medical clearance, participation in normal training activities 1
6. Return to competition: Normal game play 1

Key Requirements for Clearance

• The athlete must be completely asymptomatic both at rest and with exertion before beginning the return-to-play protocol 1, 2
• If any symptoms recur during any step of the protocol, the athlete must drop back to the previous asymptomatic level and try to progress again after 24 hours of rest 1
• Medical clearance must be provided by a healthcare professional trained in concussion management before the athlete can return to full-contact practice (step 5) 1, 3
• Neuropsychological testing, while not required in all cases, can provide objective data to help determine recovery and readiness to return to play 1, 3

Special Considerations

• Athletes with a history of multiple concussions require more conservative management and may need longer recovery periods 1
• Athletes who experienced amnesia during their concussion may have more significant deficits and slower recovery trajectories in symptoms, cognition, and balance 4
• Return-to-academics should precede return-to-play, with a gradual reintroduction to cognitive activities 5, 2
• College athletes typically have shorter recovery times than high school athletes but should still be managed conservatively 1, 4

Common Pitfalls to Avoid

• Never allow same-day return to play after a concussion, even if symptoms appear to resolve quickly 1
• Do not rely solely on the athlete's self-reported symptoms; use objective measures when available 6, 3
• Avoid premature return to play, which can increase the risk of prolonged recovery or second impact syndrome 3, 1
• Do not skip steps in the return-to-play protocol, even if the athlete appears to be recovering quickly 1

Documentation Requirements

• A regularly rehearsed emergency action plan consistent with the Concussion Safety Protocol Checklist should be in place for all suspected concussions 1
• Documentation should include symptom resolution, cognitive recovery, balance normalization, and successful completion of the stepwise return-to-play protocol 6, 3

By following these guidelines, healthcare providers can ensure that college athletes safely return to sports after concussion, minimizing the risk of long-term consequences and optimizing recovery.