An athlete has suffered a concussion. The first question asked of a treating physician is, “when can I play?” The answer to this question is, “it is complicated.”

Rest.

It’s the best treatment for concussions. That means taking a break from sports, texting, computer activity, and many other activities that stimulate the brain. Fitst, taking a break from sporting activities is important. Most athletes want to support their team, but they are better off remaining at home during this rest phase. One key step is to talk to teachers about school and classwork. School is a loud and busy place that is not conducive to healing an injured brain. Some students may even require a few days at home to support the healing process. What about texting and computer games?. Texting involves typing and rapid alternating movements with hand eye coordination. This repetitive activity is not conducive to the healing process after a concussion. Computer use and playing video games fall under the same category as texting. Limited phone calls and television are allowed.

Returning to Play.

Once all symptoms have resolved, the return to play process begins.

The progression is similar to recovering from a bone or joint injury.

Points to Remember:

• Start slow, then with a graded process, progress onto more strenuous activities.
• Return to play and return to learn can proceed at the same time.
• School can begin with half days and if tolerated progressed to full days.
  Still no testing would be recommended at this point.
• Reading and maybe homework can be attempted, but for no more than 15 to 20 minutes at a time. If at any point symptoms return, the process is halted.
• Extra time to complete assignments is recommended. Study time blocks can be increased by 15 minutes each day until return to baseline study habits.
• If at any point symptoms return, the process is halted.

Activity Guidelines for 5-Day Schedule.

Most schools have return to play protocols that usually require five days to complete. The process requires the athlete, parents, teachers, coaches, principals, athletic trainers, and physicians to work together with clear instructions lined out for all involved. The timetable is highly variable for symptoms to resolve so the return to play process can begin.

Day 1

Light exercise the first day of no more that 10 to 14 minutes is recommended. Activities that increase the heart rate such as walking, stationary bike, tredmill, etc. are suggested for use. No resistance training such as weight training should take place the first day.

Day 2

The second day involves sport specific drills with no contact.

Day 3

On the third day, resistance training may be included with the activities. Drills on day three would include more complex activities such as route running, basketball shell plays, and the like.

Day 4

The fourth day progresses to full speed practice. Authorities differ on whether or not to allow contact on the fourth day.

Day 5

Finally on the fifth day, game speed drills with contact are allowed. If the protocol is completed without a return of symptoms, the final release to play is given.

Monitoring Recovery

If symptoms occur during any phase of the return to play protocol, 24 hour rest is advised, and you begin the process again at the beginning. During this return to play protocol the athlete should be closely monitored for the return of any concussive symptoms. At times, home school or withdrawal from school may ber required to give the best chance of recovery. Computer based tests, called neurocognitive tests, may be used in conjunction with symptom history to determine when an athlete is back to baseline. Most physicians see the injured athlete on a weekly basis to determine symptom recovery. Since the activity protocol takes 5 days, the athlete will usually miss a minimum of one week. Remember, it is always best to err on the side of caution and not rush back from a brain injury.