CONCUSSIONS: Return To Play Guidelines

To Play guidelines

This is a very important part of the management of concussions. Return to play after concussion should follow a six-step process. There is no exception to the rule, these guidleines must be followed to insure the safety of our athletes.

RETURN TO PLAY

Steps to Recovery and Return to Play

A concussion is serious, but you can recover if the proper guidelines are followed. Remember, the key is REST!
It is very important that you don’t go back to practice or play if you are still showing any concussion symptoms or signs. Before returning to any physical activity, follow these steps in order.
1. No activity, complete rest. Once back to normal and cleared by a doctor, go to the next step.
2. Light exercise such as walking or stationary cycling, for 10-15 minutes.
3. Sport-specific activity (e.g., skating), for 20-30 minutes.
4. Practice puck-handling drills, shooting drills, and other activities with NO CONTACT (i.e. no checking).
5. Practice with body contact, once cleared by a doctor.
6. Game play.

Remember: Recovery is measured in steps, NOT DAYS. Progression between each stage should take a minimum of 24 hours.  Recovery is different for everybody and it takes time to make progress through each step. If any symptoms return, like a headache or nausea, stop all activity, tell someone and rest for 24 hours. Once you are no longer experiencing symptoms you should drop down to the previous stage where no symptoms occurred and try to progress again.  Seek medical attention and only return to physical activity with a doctor’s permission. If you rush your recovery, you risk suffering another concussion. It could be worse, and last much longer.

Stage	Functional Activity	Objective
1. No  activity	Complete physical and cognitive (e.g. mental)  test, until symptom free.	Recovery
2. Light aerobic exercise	Walking, swimming or stationary  bicycle keeping intensity less than 70% of maximum predicted heart rate. No resistance training.	Increase heart rate
3. Sport-specific  exercise	Skating drills in ice hockey,  running drills in soccer.  No head impact activities.	Add movement
4. Non-contact training  drills	Progression to more complex training  drills, e.g. passing drills in football and ice hockey. May start progressive resistance training.	Exercise, coordination and cognitive load
5. Full contact  practice	Following medical clearance,  participate in normal training activities.	Restore confidence and allow coaching staff to assess functional  skills by coaching staff
6. Return to play	Normal game play.

7 plus days to recover

Generally, each step should take at least 24 hours, so that, assuming  the athlete does not experience a reoccurrence of concussion symptoms at rest or  with exercise as he/she progresses through the exercise program, he/she will be able  to return to sports in about a week’s time.
If any post-concussion symptoms occur at any level,  the athlete needs to drop back to the previous level at which he/she was  symptom-free, and try to progress again after a further 24-hour period of rest  has passed.

Great website for anything related to concussions! Check it out! Stop Concussions!

Need a Concussion Management Program to help you get back in the game – ask us:  toni@stopconcussions.com.

Source: P. McCrory, W. Meeuwisse, K. Johnston, J. Dvorak, M.Aubry, M. Molloy, R. Cantu, Concensus Statement on Concussion in Sport:  The 3rd International Conference on Concussion in Sport held in Zurich, Br J Sports Med. 2009; 43:i76-i84.