Concussion Management


    Return To Play (RTP) Procedures After Concussion

    1.      Returning to participate on the same day of injury: 

    -    An athlete who exhibits signs or symptoms of concussion, any loss of consciousness, or has abnormal cognitive testing, should not be permitted to return to play on the day of the injury. Any athlete who denies symptoms but has abnormal sideline cognitive testing should also be held out of activity.

    -   When in doubt, hold the athlete out.

    2.       Return to play after concussion:

    -   The athlete must meet all of the following criteria in order to progress to activity:

    a) Asymptomatic at rest and with progressive exertion (including mental exertion in school) for at least seven days AND:

    b) Have written clearance from a preferred physician and/or neuropsychologist qualified to medically manage sports-related concussion. (Athlete must be cleared for progression to activity by a physician other than an Emergency Room or Urgent Care physician).

    3.      If there is a discrepancy between the physician’s medical release to play and the school’s policy, the school’s physician will have the final say.

    4.      Once the above criteria are met, the athlete may be progressed back to full participation under the supervision of the ATC and with clearance from a preferred physician and/or neuropsychologist qualified to medically manage sports-related concussion. The ATC will keep all pertinent parties informed regarding the status of the athlete.

    5.      Progression is individualized and will be determined on a case by case basis. Factors that may affect the rate of progression include:

    -     Previous history of concussion

    -     Duration and type of symptoms

    -     Age of the athlete

    -     Sport/activity to which the athlete will return

    6.      Graduated progression:

    1)      No activity until asymptomatic. Progress to step 2 when asymptomatic.  Step 2  is determined by the ATC.

    2)      Light aerobic exercise – walking, stationary bike. No resistance training.

    3)      Sport-specific training (e.g., skating in hockey, running in soccer)

    4)      Non-contact training drills

    5)      Full-contact training after medical clearance

    6)      Game play

    Note: If the athlete experiences post-concussion symptoms during any phase, the athlete drops back to the previous asymptomatic level and resumes the progression after 24 hours.

    7.    The ATC and athlete will discuss appropriate activities for the day. The athlete will be given verbal and written instructions regarding permitted activities.

    8.   The athlete should see the ATC and/or school nurse daily for re-assessment and instructions until progressed to unrestricted activity, and given a written report from the ATC. A plan between the ATC & school nurse will be developed to determine who will re-assess the athlete and the time frame in which the re-assessment will take place. The ATC will continue to monitor the athlete after full participation for recurrence of signs or symptoms over the next few days.