When can you return to play after a concussion?

Let's face it, no one wants to get hurt playing sports, but not all injuries are created equal. Playing through a mild injury to the ankle, knee, or shoulder is something that most players are happy to do, but playing through a head injury of any intensity is a recipe for long term issues.

Concussions are one of the most serious injuries in sports, however proper management and return to play guidelines will help minimize negative long term effects. Every concussion is different and each individual must be treated based on their unique presentation. Concussions are no longer graded as mild, moderate, and severe, and although this makes it more difficult for coaches to prepare for a player's return, it also eliminates the pressure or stigma when a player takes "longer" than predicted to recover.

Fortunately, the vast majority of concussions result in less than 2 weeks of missed time. The remaining concussions may take weeks, months, or longer to fully heal. The management of these concussions is slightly different with an extended period of rehabilitation, however each concussed individual will need to progress through the same steps when looking to return to sports.

Following a concussion, athletes will be monitored and progressed based on their symptoms which include headache, dizziness, feeling in a fog, nausea, memory and cognition, special tests that assess eye movements, ability to resume reading and computer skills, as well as computer-based neuropsychological testing.

Computer-based neuropsychological testing, such as ImPACT, has assisted medical professionals and athletes with return to play decisions over the past 10-15 years. ImPACT is better able to detect subtle changes in brain function, such as reaction time, compared to a typical examination. Baseline ImPACT tests are now administered to nearly all professional and college teams, and many high school and youth organizations. These tests assess function in the healthy uninjured brain. If an injury occurs, testing can be compared to the original test and/or to norms that have been established for age, sex, education level, etc. When used in conjunction with a medical professional's objective examination and patient's reported symptoms, return to play decisions can be made with increased confidence.

When symptoms resolve with rest and the physician's objective examination is passed, a gradual progression of activity begins assuring that the athlete does not have an increase in symptoms. If signs or symptoms return at any point, the level of activity is decreased until the individual can tolerate it without additional symptoms. The following are recommendations from University of Pittsburgh Medical Center(UPMC) regarding progression of athletes following a concussion. The key is that each individual will progress at his/her own pace. Once the individual has completed all five steps without an increase in signs or symptoms of a concussion, they may return to play in a game.

Each athlete needs to complete each of the following stages of progressive activity:

Stage 1 – 30 -40% max heart rate, 10 -15 min of cardio exercise, very light aerobic conditioning, stretching, and very low level balance.

Stage 2 – 40-60% max heart rate, 20 to 30 min of cardio exercise moderate aerobic conditioning, light weight strengthening, and low level balance activities.

Stage 3 – 60-80% max heart rate, strengthening, conditioning, balance, and concentration activities, moderate aggressive aerobic exercise, 80% max strengthening activities, and impact activities such as running and plyometrics.

Stage 4 – 80-90% max heart rate, resume aggressive training in all environments, non-contact only, aggressive strength training, and sports specific training.

Stage 5 – 100% max heart rate, contact activities that are sport specific, full training with contact and continue aggressive strength training.

Return to play decisions following a concussion can be difficult; however with proper medical guidance and honesty from athletes, the likelihood of a second concussion greatly decreases. Remember we only get one brain, treat it kindly.

Read more Sports Doc for Sports Medicine and Fitness.