Return to Action Steps for Post-Concussion Athletes
In 2009, there were 446,788 head injuries treated in US emergency rooms, and that number doesn’t reflect the staggering amount of head injuries that go untreated yearly. Generally, 21% of traumatic brain injuries experienced by American children and adolescents are caused by sports and sport-related activities. In recent years, health-care providers have discovered the importance of treating head injuries, such as concussions, very seriously and are developing standardized methods of treatment.
When a player or athlete sustains a concussion, it is crucial that certain steps are followed prior to a safe return to play. Further, the steps need to incorporate a certain amount of flexibility, as concussions affect individuals differently and need to be handled accordingly.
What is a Concussion?
In January of 2014, a Safety in College Football Summit was held to discuss improvements in safety culture. The intent was to bring experts together that could modify safety in intercollegiate sports, especially football. Of the key issues discussed, there was a prominent focus on concussion diagnosis and management. The term “concussion” has over 42 definitions, but they found the best evidence-based meaning is, “a change in brain function following a force to the head, which may be accompanied by temporary loss of consciousness, but is identified in awake individuals with measures of neurologic and cognitive dysfunction.”
The student-athlete’s health care provider diagnoses sport-related concussions, but identifying a concussion can be a challenge. Neuropsychological tests like a CT or brain MRI are useful as additional tools in diagnosis, but there is controversy on the interpretation of these tests as clinical tools. Sports-related concussions may be subtle and might not show normal or average symptoms. On the other hand, concussion-specific symptoms that are displayed could be a sign of other unrelated conditions or underlying issues.
Concussions have a bad reputation for delayed symptoms that will manifest later and lead to a false clean bill of health. The biggest challenge of diagnosing a sports-related concussion doesn’t involve the injury, but the athlete themselves. Student-athletes will underreport symptoms in order to continue playing, or exaggerate recovery so they may be cleared to play faster. Health-care providers have to be wary and observe each student-athlete for irregular behavior or concerning symptoms.
Return to Action Steps
The timeline for a return to full activity is difficult to determine as each athlete experiences concussions uniquely. It may take 7 to 14 days starting from the first day the player reaches their baseline. The baseline is determined by the health-care provider before activity has begun. It measures an athlete’s average physical and cognitive state as well as their vitals. It is critical that they always return to their baseline, or else something more may be wrong.
Once an athlete is involved in a sports-related concussion, they need to be removed from play immediately. If they are cleared, they can return. If not, they cannot return to play and must focus on their recovery. After 24 asymptomatic hours, or once their baseline is reached, the return to action progression can begin.
- Light aerobic exercise: Walking swimming, or stationary bike are a few examples of what is considered light aerobic exercise. No weights, contact, or resistance training allowed. If the athlete is asymptomatic and returns to their baseline, they can move on to the next step.
- Sport-based exercise: Exercises specifically related to the athlete’s sport can be reintroduced, but with a focus on limited head movement. If the athlete is asymptomatic and returns to their baseline, they may move to the next step.
- Non-contact drills and practice: The athlete may resume practice as long as there is no contact and focus on rest. They can practice close to full time as well as reintroduce resistance training, and if asymptomatic they can return to full contact practice.
- Full contact practice: If the athlete is continues to show no sport-related concussion symptoms, they can return to full-time practice. This is the last step before return to action can be reached, and a health-care provider will decide at this point if the athlete is ready to return to play. Sometimes, they will decide the athlete needs to take a step back if symptoms return at this time. If not, they can clear the athlete and they can return to full play.
- Return to play: Once medical clearance is given, the athlete can return to play. Sports-related concussions are serious and everyone needs to be vigilant. Coaches and players alike need to be aware of the symptoms, the risks, and the consequences to prevent any undiagnosed concussions from going without immediate treatment.
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