A concussion is a mild traumatic brain injury from a jolt or blow to the head, or a hit to the body that causes the head to move rapidly. This movement can cause temporary changes in brain function. Safely returning to sports after a concussion is important for an athlete’s health. This article explains the process for safely resuming physical activity and competition.
Understanding Concussion Recovery
Concussion recovery is a highly individualized process. The brain needs time to heal from forces that disrupt its function. After a concussion, the brain redirects energy to repair damaged cells, causing fatigue.
Initial recovery involves “brain rest,” with physical and cognitive limitations. This means reducing activities demanding mental or physical energy, like schoolwork, video games, or strenuous exercise, to allow the brain to heal. Symptoms like headaches, dizziness, difficulty concentrating, or sensitivity to light and sound must fully resolve before returning to activity.
Symptoms can emerge immediately or develop hours to days after the injury. If symptoms return or worsen with activity, the brain has not fully recovered, necessitating further rest.
The Graduated Return-to-Play Protocol
Once concussion symptoms resolve at rest, athletes typically follow a structured, graduated return-to-play (GRTP) protocol to gradually reintroduce physical and cognitive demands. This stepwise approach ensures the brain can tolerate increasing activity without symptoms returning. Each stage requires a minimum of 24 hours without symptom recurrence before advancing. If symptoms reappear, the athlete must revert to the previous symptom-free stage.
The protocol begins with light aerobic exercise, such as walking or stationary cycling, to elevate heart rate without significant head movement. The next stage involves sport-specific exercise, like running drills, without head impact activities. Next, athletes progress to non-contact practice, participating in more complex drills and resistance training with their team.
After non-contact activities, the athlete moves to full-contact practice, allowing participation in scrimmages and drills involving potential head contact. The final stage is a full return to competition, but only after completing all previous stages symptom-free and receiving medical clearance. This progression minimizes re-injury risk and ensures the brain is prepared for sport demands.
Risks of Rushing Return
Returning to sports before a concussion has fully healed carries risks. One risk is Second Impact Syndrome (SIS). SIS occurs when an athlete sustains a second head injury before recovering from an initial concussion. This can lead to rapid brain swelling, which may result in severe disability or even death.
Even a minor second impact can trigger SIS if the brain is vulnerable. Beyond SIS, rushing a return can prolong Post-Concussion Syndrome (PCS), where symptoms like headaches, dizziness, and cognitive difficulties persist for weeks, months, or longer. These prolonged symptoms can impact an athlete’s academic performance, mental health, and quality of life.
Studies indicate athletes who return to sport too soon face a higher risk of other injuries, such as ligament tears or sprains, due to impaired balance, reaction time, and altered movement. These injuries can sideline an athlete longer than the concussion itself. Adhering to recovery protocols helps mitigate these risks.
The Role of Medical Professionals
Return-to-play decisions after a concussion must be made by a qualified healthcare professional experienced in concussion management. This ensures an objective assessment and prioritizes the athlete’s health over immediate return to competition. Athletes, parents, or coaches should not decide independently.
Healthcare providers, such as physicians, sports medicine specialists, or neurologists, use expertise, clinical evaluations, and sometimes neurocognitive testing to determine readiness. Neurocognitive tests assess cognitive functions like memory, attention, and processing speed, revealing subtle impairments even when an athlete feels symptom-free. Baseline testing, conducted before an injury, provides a comparison point for post-concussion assessments.
Medical clearance is typically required in writing before an athlete begins the graduated return-to-play process and returns to unrestricted activity. This oversight helps prevent premature returns that could lead to complications, emphasizing professional guidance throughout recovery.