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AI-Generated response:

When can an athlete return to training after a concussion?

Answer generated on June 4, 2024

The AI-generated responses are for illustration purposes only and should not be used for medical purposes.

An athlete can return to training after a concussion following a symptom-free period and a graduated return-to-play (RTP) protocol, typically involving a minimum of 5 days.[1]

  • The RTP protocol includes stages starting from physical rest, progressing through light aerobic exercise, sport-specific exercise, noncontact training drills, full contact practice, and finally normal game play.[1]

  • Athletes must be completely asymptomatic, off medications for concussion symptoms, and back to baseline functioning in all tested domains before advancing in the RTP stages.[1]

  • If symptoms recur at any stage, the athlete must return to the previous asymptomatic level and rest until symptoms resolve before attempting to progress again.[1-2]

  • The final decision on RTP should be made by a licensed clinical provider with experience in managing sports-related concussions.[1]

  • Local laws or school policies may require an extended minimum number of symptom-free days before RTP, which must be adhered to.[1]

Additional info

The RTP protocol is designed to ensure the safety and health of the athlete by preventing premature return to sport, which can lead to complications such as second impact syndrome—a condition with a high risk of severe neurological injury or death if a second concussion occurs before the first one has fully healed.[3] The protocol's staged approach helps in monitoring the athlete's ability to handle increasing physical demands without exacerbating symptoms. Clinicians should also consider individual factors such as the athlete's age, history of previous concussions, and the severity of the concussion when making RTP decisions. It's crucial to follow these guidelines closely to safeguard the athlete's long-term health and career.

References

Reference 1

1.

Taylor, Alex M., Meehan, William P., Proctor, Mark R. (2025). Sports-Related Traumatic Brain Injury (Concussion). In Nelson Textbook of Pediatrics (pp. 4314). DOI: 10.1016/B978-0-323-88305-4.00729-X

There is a six-stage return-to-play (RTP) protocol for a safe return to activities (seeTable 729.2). Starting with physical rest, athletes are progressed to light aerobic exercise, moderate levels of sport-specific exercise, noncontact training drills, full contact practice, and normal game play. Athletes should be completely asymptomatic, free of medications used to treat concussion symptoms, at full school, and back to baseline functioning on all domains tested before the injury before returning to contact or collision sports. Children and adolescents should remain at each stage of rehabilitation for no less than 24 hours before advancing to the next level. Thus a minimum of 5 days should pass before consideration of full return to competition. If symptoms return at any stage of exertion, the athlete should rest until the symptoms resolve and then return to the previous level of exertion. The final decision for RTP should be made by a licensed clinical provider with experience in the evaluation and management of sports-related concussions. Note that some states or schools require an extended minimum number of symptom-free days before RTP, so clinicians need to be aware of the laws or local recommendations regarding RTP.

Reference 2

2.

Concussion, Elsevier ClinicalKey Derived Clinical Overview

• Physiologic recovery is slower than symptomatic recovery. Protocols involving a symptom-free waiting period before return to play are warranted.Table 4summarizes recommendations on returning to play after a concussion. CDC protocols for managing return to activities after concussionare described inTable 5. Physical and cognitive rest are the cornerstones of initial concussion management, with subsequent gradual return to school and physical activities. Repeated concussions, especially within days or weeks, carry a significant risk of permanent brain injury (second impact syndrome). • If concussion symptoms occur with activity at one level, the athlete should stop the activity, rest until symptoms resolve, and then restart his or her progression at the level that did not elicit symptoms. • There are no evidence-based guidelines for disqualifying or retiring an athlete from sport after a concussion. Each case should be individually considered.

Reference 3

3.

Sports Participation Evaluation in Adolescents, Elsevier ClinicalKey Clinical Overview

Special Considerations Patients may report history of earlier sports-related head injury or concussion, or review of systems may find concussionlike symptoms. In this scenario, a complete neurologic examination should be performed Athletes with ongoing signs and symptoms of concussion should not be cleared for participation until all symptoms have resolved Concussion symptoms include: Headache Dizziness Nausea or vomiting Difficulty concentrating Fatigue or sleepiness Slurred speech Blurred or double vision Confusion Because many teens may report these symptoms even without concussion, consider using validated tools such as the SCAT (Sport Concussion Assessment Tool) to establish a baseline in patients at higher risk of concussion injury. SCAT-5 Neuroimaging is not indicated unless intracranial bleeding, serious brain injury, and/or cervical spinal injury is suspected or cannot be ruled out; concussion symptoms are not caused by macroscopic neural damage but rather by disturbances in neurochemical pathways at the cellular level A second injury before the brain has fully recovered results in worsening of the cellular metabolic changes and decrease in cognitive function Second impact syndrome Rare condition in which athletes sustain a second head injury before symptoms of the initial concussion have fully resolved Mortality rate is nearly 50% and morbidity rate is nearly 100%; this emphasizes the importance of allowing the brain to fully heal before return to the activity that caused the initial concussion Athletes are considered clinically recovered when asymptomatic at rest and able to participate in usual activities without symptoms, including school, work, and sports Expected time frame to recover from a concussion is 2 weeks in adults and 4 weeks in children The baseline comparison method, in which an athlete’s postconcussion performance is compared with a healthy baseline evaluation from before the athletic season, has been described as the gold standard in concussion management by some experts Several tools have been suggested as adjuncts to the SPE, including: Baseline computerized neurocognitive testing Child and adult SCAT-5 (Sport Concussion Assessment Tool, fifth edition) Graded symptom checklists Balance Error Scoring System Tandem gait King-Devick test Vestibular Ocular Motor Screening

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