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Topic Overview

Anyone who has a head injury during a sporting event needs to immediately stop all activity and not return to play that day. Being active again before the brain returns to normal functioning increases the person's risk of having a more serious brain injury.

Every person involved in a sporting event (every coach, player, teacher, parent, and trainer) needs to be trained to know the symptoms of a concussion. And all need to know the importance of getting medical help when a player has a head injury.

The decision about when a player can safely return to play must be made by a doctor. The doctor decides on a case-by-case basis. Things that help the doctor decide when the player can return to play include:

• The symptoms the player has.
• The player's medical history.
• The player's concussion history.
• The player's medicine use.
• The type of sport and the position played.
• The player's ability to stand and keep his or her balance.
• The player's ability to pay attention and to answer questions that test learning and memory.
• How quickly the player can solve problems.

Doctors and other concussion specialists agree that a player must not return to play until symptoms are completely gone, both at rest and during exercise or exertion. Using medicine to improve concussion symptoms is not the same thing as being symptom-free. Medicines must be stopped before an athlete can be considered symptom-free. Children and teens have longer recovery times. So they may have to wait longer before they can return to play.

The first treatment for a concussion is rest, both physical and mental. The return to play needs to occur in a gradual, step-by-step way:¹

1. No activity. This means complete physical and mental rest.
2. Light aerobic activity. This can include walking, swimming, or other exercise at less than 70% maximum heart rate. No resistance training is included in this step.
3. Sport-specific exercise. This includes skating drills or running drills (depending on the sport) but no head impact.
4. Non-contact training drills. This includes more complex training drills such as passing. The athlete may also begin light resistance training.
5. Full contact practice. A medical professional must agree that the athlete is ready. The athlete can participate in normal training.
6. Return to play. This is the final step and allows the athlete to join in normal game play.

The athlete must be symptom-free for 24 hours at the current level of activity before moving on to the next step. If one or more symptoms return, the player needs to go back to the previous level of activity with no symptoms for at least 24 hours before trying to do more. A doctor must always make the final decision about whether a player is ready to return to full-contact play.

These general rules apply to return to play after a first concussion. After more than one concussion, the player will most likely need a longer recovery time. Because the risk for a second concussion is greatest within 10 days of the first concussion, it's very important to make sure the player is completely recovered before he or she returns to play. A second injury, even if it is not a head injury, could cause permanent brain damage or death.