When can a 15-year-old female patient, who suffered a head injury 7 days ago and has been experiencing slight dizziness and sensitivity to light, but no longer has a headache, return to sports?

Return to Sports After Concussion in Adolescent Athletes

This 15-year-old cannot return to sports yet because she still has active concussion symptoms (dizziness and photophobia) and must be completely asymptomatic at rest and with exertion before even beginning the graduated return-to-play protocol, which itself requires a minimum of 5 additional days. 1, 2

Current Status Assessment

Your patient is 7 days post-injury but remains symptomatic:

• Active symptoms present: Slight dizziness and light sensitivity (photophobia) are clear concussion symptoms that prohibit any progression toward return to play 1, 2
• The fact that she had a headache yesterday (day 6) and reports "no longer having" one today suggests very recent symptom resolution for that particular symptom, but other symptoms persist 1
• She does not meet the prerequisite criteria to begin the return-to-play protocol 1, 2

Prerequisites Before Starting Any Return-to-Play Protocol

She must meet ALL of the following criteria before beginning the stepwise progression 1:

• Complete resolution of ALL symptoms at rest (no headache, dizziness, nausea, photophobia, or cognitive difficulties) 1, 2
• Normal neurological examination 1
• Normal cognitive evaluation 1
• Asymptomatic with physical exertion 1, 2

Currently, she fails the first criterion due to ongoing dizziness and photophobia.

Timeline Once She Becomes Asymptomatic

When she finally becomes completely asymptomatic at rest AND with exertion, she must then complete a mandatory 6-stage graduated protocol 1, 2:

Minimum 5-day progression (each stage requires at least 24 hours) 1, 2:

1. Stage 1: Complete rest (physical and cognitive) 2
2. Stage 2: Light aerobic activity (walking, swimming, or stationary cycling at ≤70% maximum heart rate, no resistance exercises) 2
3. Stage 3: Sport-specific exercise 1
4. Stage 4: Non-contact training drills (more complex drills, light resistance training may begin) 2
5. Stage 5: Full-contact practice (requires medical clearance first) 2
6. Stage 6: Return to game play 2

Special Considerations for This Adolescent Patient

Pediatric athletes require longer recovery than adults—typically 7-10 days or longer for full cognitive recovery, even after becoming asymptomatic 2. A more conservative approach with slower progression is warranted for adolescent populations 1.

Critical Management Rules

• If symptoms recur at any stage: She must immediately stop all activity, rest for at least 24 hours until asymptomatic again, and drop back to the previous asymptomatic level 1, 2
• Written medical clearance from a licensed healthcare provider trained in concussion management is required before return to full-contact practice and competition 1, 2
• After 24-48 hours of initial rest post-injury, gradual resumption of cognitive and physical activity is appropriate, but prolonged complete rest can actually be detrimental 3

Practical Answer for This Patient

Earliest possible return to competition: At minimum 5 days AFTER she becomes completely asymptomatic at rest and with exertion 1, 2. Since she is currently still symptomatic at day 7, she needs:

1. Additional days until complete symptom resolution (unknown duration)
2. Plus minimum 5 days for the graduated protocol
3. Realistic estimate: Likely 12-14+ days from original injury, possibly longer given her persistent symptoms at day 7 2

Common Pitfall to Avoid

"When in doubt, sit them out" is paramount in pediatric concussion management 2. Same-day return to play is absolutely contraindicated in all cases 1, and rushing the protocol increases risk of second impact syndrome and long-term complications 2.