Question

When can a student athlete return to play after a concussion?

Answer 1

Student athletes are ready to return to play when they are:

• 100% symptom free at rest.
• 100% symptom free with normal mental activity.
• 100% symptom free with exercise.
• No longer taking any medications for concussion symptoms.
• Fully back to school and able to tolerate school work.

And

• Have a post-concussion neurocognitive test (ImPACT or other symptom and assessment tool) score that is at least as good as the pre-concussion score or pass certain criteria set by the school or athletic board.
• Have a physical exam and balance test that are within normal limits.
• Have been cleared for play by a healthcare provider trained in evaluating and managing concussions.

The thinking used to be that the student athlete needed to be symptom free for 24 hours before starting the multiphase process of physical activity toward the goal of returning to play. However, research has now shown that if the patient’s concussion symptoms are improving each day and they are able to attend a full school day with a few breaks for symptoms, they can begin to add very low level cardiovascular activities. These activities should consist of walking or biking on a stationary bike at an intensity that doesn’t make symptoms worse.

With the help of an athletic trainer or physical therapist, athletes can begin to increase their activity level each day, making sure they can tolerate increasing how hard they exercise over time without triggering symptoms before moving on. For example, start out slow with aerobic exercise, then move on to sport-specific drills, then contact activities and finally full participation. This step up in activity can take up to 10 days or longer, as each increase in activity may bring on symptoms and require rest and return to the previous step.

Following this approach, most student athletes are able to return to play within about three weeks after their symptoms began.