Sunday, November 13, 2016

Through an Athletic Trainer’s Eyes: Concussion Return to Play Protocol

As stated in the previous blog, concussions have become a growing conversation piece over the last several years. The recognition of concussion signs and symptoms are an important step to the management of concussions. However, recognition is only the first step of the concussion management process. Once a concussion has been determined by the athletic trainer or physician, the next steps of concussion management are just as important.
In order to begin the return to play protocol, the athlete must be symptom free for at least 24 hours and must be cleared by the physician.  Typically the athlete can expect to be out of competition for at least one week¹. The athlete should also be able to perform  all of the concussion objectives at a normal or above the pre-injury status. This can be determined by a computerized Impact test or a SCAT 3 test, two of the most commonly used methods for concussion testing.
Each Athletic trainer may have their own variation of return to play protocol but typically it will follow a general guideline.²
Each rehabilitation stage should begin a minimum of 24 hours apart. If the athlete becomes symptomatic during one of the phases the athlete must stop activity until the symptoms are resolved again. Once the athlete has become symptom free, they may resume the return to play process at the previous asymptomatic stage.² The return to play protocol may be adjusted to best suit the athlete and their sport. It is important to follow the return to play protocol strictly to avoid further injury to the athlete.
When it comes to medications, there is limited evidence that states if there are any  which are beneficial to the healing process for concussion recovery. It is suggested that non-steroidal anti-inflammatory drugs, such as aspirin, may be harmful to the recovery process because they decrease platelet function and may increase intracranial bleeding.¹ To ease the pain of the concussion headaches the athlete may take Acetaminophen, better known as Tylenol, sparingly.  
Just as it is important to be able to recognize the signs and symptoms of a concussion, it is also important to understand the return to play protocol. This part of concussion management should not be rushed or taken lightly. Failure to properly conduct the return to play protocol can result in further injury to the athlete.

¹Broglio, S. P., PhD, ATC, Cantu, R. C., MD, Gioia, G. A., PhD, Guskiewicz, K. M., PhD, ATC, FNATA, FACSM, Kutcher, J., MD, Palm, M., MBA, ATC, & Valovich McLeod, T. C., PhD, ATC, FNATA. (21014). National Athletic Trainers’ Association Position Statement ... Retrieved October 27, 2016, from

²Sport Concussion Assessment Tool (SCAT3) - BMJ Journals. (2016, October 26). Retrieved October 27, 2016, from

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