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Concussion Management

Returning to Play (Sports)

Guiding the recovery of individuals of any age with MTBI who participate in competitive or recreational activities requires careful management to avoid re-injury or prolonged recovery. Athletes engaged in collision sports require special management and evaluation to ensure full recovery prior to their return to play.

An individual should never return to competitive sporting or recreational activities while experiencing any lingering or persisting MTBI symptoms. This includes PE class, sports practices and games, and other high-risk/high-exertion activities such as running, bike riding, skateboarding, climbing trees, jumping from heights, playful wrestling, etc. The individual should be completely symptom free at rest and with physical exertion (e.g., sprints, non-contact aerobic activity) and cognitive exertion (e.g., studying, schoolwork) prior to return to sports or recreational activities.

Along with parent and teacher observation for continuing signs or symptoms of concussion, objective data in the form of formal neuropsychological testing may provide valuable information to assist with return to play decisions in younger athletes, as their symptom reporting may be more limited and less reliable. Formal neuropsychological testing of competitive athletes may also help physicians with return to play decisions, as athletes may minimize their symptoms to facilitate return to play.1

It is important to inform the athlete's coach, PE teacher, and/or athletic trainer that the athlete should not return to play until they are symptom-free and their cognitive function has returned to normal, both at rest and with exertion.

Return to play should occur gradually. Individuals should be monitored for symptoms and cognitive function carefully during each stage of increased exertion. Patients should only progress to the next level of exertion if they are asymptomatic at the current level. In competitive sports, a specific return to play protocol outlining gradual increase in activity has been established by the Concussion in Sport Group:1

  • Rest
  • Aerobic exercise (.e.g., stationary bicycle)
  • Sport Specific training (e.g., running, skating)
  • Non-contact drills (includes cutting and other lateral movements)
  • Full-contact controlled training
  • Full-contact game play


spine Brain Injury

Compassionate Care


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