There are no hard and fast rules for when athletes are permitted to return to the sport they love aside from the accepted practice that “same game” returns are not recommended. It was previously thought that athletes could return to play if they had only received a grade 1 concussion and they quickly returned to baseline. This is no longer the standard of care for concussion management. The grading system is less emphasized than previously and individual athletes are measured using sideline tests that measure cognitive functions such as concentration, memory, and orientation.
Return to play should be carefully managed by the team physician and trainer. No player should go from zero percent play to 100 percent play without monitored, “symptom free” exertion. In the context of youth sports, CAMP offers preseason training and support to coaches, parents, and players about concussion and the consequences of returning to the game before being fully healed. As with other medical history, it is a good idea to have an idea which athletes may be more vulnerable to concussion before competition begins. Returning to play after concussion requires a stepwise process that monitors athletes at each phase of their return. Athletes are followed during recovery with exertional testing and should not play if they are at all symptomatic. In cases where no physician or trainer are available coaches and parents often supervise the specific exertion protocol outlined by the physician or concussion specialist. I spend a fair amount of time teaching the re-exertion steps necessary for safe return-to-play. A specific return to play protocol outlining gradual increase in activity has been established by the Concussion in Sport Group as follows (Aubry, Cantu, Dvorak, Graf-Baumann, Johnston, Kelly, Lovell, McCrory, Meeuwise, Schasmasch, 2001. Clinical J. Sports Med.) There is a subset of athletes whose recovery will not follow this protocol because of previous concussions.