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Concussion—Treatment and Return to Play

As a sports oriented specialist, I hear a lot of discussion about concussions from patients, parents, and coaches. There are some high profile stories in the news that draw people’s attention and make people start thinking about these issues more.

Concussion

Understanding what a concussion is, how it should be treated, and when it is safe to return to activities are important for the athlete, parent, and treating physician. Below is a brief outline of the guidelines for returning to athletics after a concussion and some links to additional information.

Return to Play

Baseline (Step 0): After a concussion is diagnosed, or suspected, the athlete should be immediately removed from participation in athletic activities. The athlete needs to symptom-free for a minimum of 24 hours before starting this phased recovery. Keep in mind, the younger the athlete, the more conservative the treatment.

Step 1: Light Aerobic Exercise

The Goal: only to increase an athlete’s heart rate.
The Time: 5 to 10 minutes.
The Activities: exercise bike, walking, or light jogging.
Absolutely no weight lifting, jumping or hard running.

Step 2: Moderate Exercise
The Goal: limited body and head movement.
The Time: Reduced from typical routine
The Activities: moderate jogging, brief running, moderate-intensity stationary biking, and moderate-intensity weightlifting

Step 3: Non-contact Exercise

The Goal: more intense but non-contact
The Time: Close to Typical Routine
The Activities: running, high-intensity stationary biking, the player’s regular weightlifting routine, and non-contact sport-specific drills. This stage may add some cognitive component to practice in addition to the aerobic and movement components introduced in Steps 1 and 2.

Step 4: Practice

The Goal: Reintegrate in full contact practice.

Step 5: Play

The Goal: Return to competition