From the Guidelines
The post-concussion protocol for athletes returning to sports involves a gradual, step-by-step approach that should only begin after the athlete is completely symptom-free at rest, as recommended by the American Academy of Pediatrics in 2010 1. First, the athlete should receive clearance from a healthcare provider experienced in concussion management before starting any return-to-play protocol. The protocol typically consists of six progressive stages:
- complete rest until symptom-free;
- light aerobic exercise like walking or stationary cycling at low intensity;
- sport-specific exercise without head impact;
- non-contact training drills with increased complexity;
- full-contact practice after medical clearance; and
- finally, return to competition. Each stage should last at least 24 hours, and if any symptoms return during a stage, the athlete must return to the previous symptom-free stage. This gradual approach is crucial because premature return to activity risks prolonging recovery and increases the risk of second impact syndrome, which can cause severe brain injury, as noted in the study by the American Academy of Pediatrics in 2010 1. Athletes, especially younger ones whose brains are still developing, should never return to play on the same day as a concussion, regardless of symptom resolution, as emphasized by the American Academy of Pediatrics in 2010 1. Proper recovery is essential as the brain is particularly vulnerable to additional injury during the healing process, and multiple concussions can lead to long-term neurological problems, as highlighted in the study by the American Academy of Pediatrics in 2010 1. The use of the postconcussion symptom scale, as described in the study by the American Academy of Pediatrics in 2010 1, can help track progress toward symptom resolution and guide the return-to-play decision. Overall, the key to a safe and successful return to play after a concussion is a gradual, step-by-step approach that prioritizes the athlete's brain health and safety above all else, as recommended by the American Academy of Pediatrics in 2010 1.
From the Research
Post Concussion Protocol for Athletes
The post concussion protocol for athletes returning to sports involves a gradual and structured approach to ensure safe and effective recovery. The key components of this protocol include:
- A six-step process for gradual return to play (RTP) as recommended by the International Conference on Concussion in Sport 2
- Sport-specific return to play guidelines that take into account the variability of different sports and the resulting challenges medical professionals face in making sure each athlete is able to withstand the rigors of their specific sport 2
- A seven-step program that includes a moderate activity phase with resistance training, and contact and limited contact drills specific to the athlete's sport and/or position 2
- The final RTP determination should occur with documented medical clearance from a licensed healthcare provider who has been trained in the evaluation and management of concussions 2
Key Principles of Concussion Management
The management of concussed athletes involves the four Rs: recognition, response, rehabilitation, and return 3. The rehabilitation process includes:
- Rest, both physical and cognitive, as the first step
- A step-wise return to activity once asymptomatic at rest
- A protocol that may be adapted for various sports and age groups, with a more conservative approach for children 3
Vestibular Rehabilitation and Concussion
Vestibular rehabilitation exercises may help patients with concussion, particularly those with persistent vertigo, dizziness, and balance dysfunction 4. However, the current evidence for optimal prescription and efficacy of vestibular rehabilitation therapy (VRT) in patients with mild traumatic brain injury (mTBI)/concussion is limited 4.
Evaluation and Management of Concussion
Concussion evaluation and management involve a comprehensive approach that includes treatment of common symptoms such as headaches, dizziness, sleep disturbance, psychiatric symptoms, and cognitive issues 5. The decision to return to play is clinically based, with scant objective measures to guide decision making 6.