According to the International Guidelines for Concussion in Sport, there is a very specific protocol that must be followed prior to allowing an athlete that has sustained a concussion to return to sport. Before considering return to sport, the athlete needs to have clearance from their medical provider, should have relative rest from demanding physical and thinking activities at least 24-48 hours following the concussion, and should no longer be experiencing any concussion symptoms with regular daily work/school activities.
Following ability to complete all work and/or school activities without any symptoms, an athlete may begin the stepwise progression for return to sport. Each step takes a minimum of 24 hours to complete and the athlete can not experience any symptoms during that stage. If an athlete does experience onset of symptoms at a stage, they should return to the previous stage until asymptomatic. If symptoms are persisting greater than two weeks, the athlete should be referred to an appropriate healthcare provider with experience in concussion management.
The table below is an applied example of what return to sport would look like for a Lacrosse athlete. This example was created based up on the guidelines from the Graduated Return to Sport Strategy from the Consensus statement on concussion in sport—the 5th international conference on concussion in sport held in Berlin, October 2016 https://dx.doi.org/10.1136/bjsports-2017-097699
| Concussion Occurred | Saturday | Athlete sustained concussion during Lacrosse game, pulled out of remainder of game |
| Stage 1 | Sunday, Monday, Tuesday | Athlete still feels light-headed and has headache on Sunday and Monday by end of day with return to classes, no symptoms all day on Tuesday |
| Stage 2 | Wednesday | 10 minutes of stationary biking or walking to get heart rate up, no lightheadedness or headache afterward |
| Stage 3 | Thursday | Jogging at moderate pace, athlete has headache afterward |
| Repeat Stage 3 | Friday | Jogging at moderate pace, no symptoms |
| Stage 4 | Saturday | Lacrosse specific drills including sprinting, passing, shooting (all non-contact), no symptoms |
| Stage 5 | Sunday | Return to controlled practice (can be contact) after medical clearance, no symptoms |
| Stage 6 | Monday | Athlete may return to game play |
For more information on concussions, check out some of our other blogs in this series…
What is a concussion?
A concussion is classified as a mild traumatic brain injury; however, just because it is classified as “mild” doesn’t mean that its effects are not serious.
Physical Therapy After a Concussion
This is a question that I get a lot from patients and physicians, and surprisingly there is actually a lot that a physical therapist trained to treat concussions can do to help!
