Concussion: Return to Learn/Play

The return to play decision after a possible concussion is a decision that should be made very carefully and with the help of trained medical professionals. It is also critical to address the return to learn (school) process as most schools do not have any written policy.

We strongly recommend that you read the guidelines published in the Consensus statement on concussion in sport—the 5th international conference on concussion in sport held in Berlin, October 2016

Our intent is to help you sort through these guidelines and terminology so you can arrive at a carefully considered decision for your child and know the exact date that your child can safely return to their sport(s).

1. Do not return your child to sport for at least 24 hours after a possible concussion.

2. Seek professional medical advice before returning your child to sports and school.

3. Most sports organizations (schools, leagues, clubs) require a doctor's note before return to play clearance is granted. The return to learn process frequently requires direct contact with school administrators.

"Concussion protocol" vs "Return to Sport (Play) protocol"

Yup, it is confusing! The terminology in the professional guidelines vs. and the terms the media use are not consistent. The "Concussion Protocol" has no professional definition. The media typically uses this terminology to mean that the athlete has been removed from play for a possible concussion and the athlete has not yet been returned. The Return to Sport protocol is a professional term. This is explained in detail below.

Read Return to Learn (RTL) and Return to Sport (RTS) Protocols for Youth Athletes and Our Proposed Coordinated Return Protocol

Doctor's Note

 

Click here. What does the date on the doctor's note mean? Please read the explanations below.

1. The note asks the doctor to confirm that he/she is familiar with the most current concussion care guidelines. This way you know your doctor "knows."

2. The note has 4 options:

□ No Concussion/Head Injury. This athlete has been fully evaluated. The diagnosis that explains the athlete’s current condition is: ___________________________________________________________________ Athlete may immediately resume all activities without restriction on this date: ___________________.

** This option means that the doctor is confirming that there is NO concussion/head injury and that your child may return to play on the date provided.

□ This athlete has sustained a concussion/head injury. Do NOT return to strength and conditioning, sports practice, or sports competition at this time. Return for further evaluation in ____________ days or ___________ weeks.

** This option means that the doctor says your child has sustained a concussion, may NOT return to strength and conditioning, sports practice, or sports competition and must return for further evaluation before any return to play date is provided.

□ Concussion/Head Injury Resolved - May Begin Return to Sport Protocol on this date: ___________. Return to Sport Protocol must be supervised by a health care provider.

** This option means that the doctor says your child may begin the Return to Sport protocol on the date provided. The Return to Sport protocol does NOT mean your child can return to playing sports just yet. It means that your doctor is recommending that a medical professional supervise a step by step return to physical activity which ends with your child returning to his/her sport. See below for a full explanation of the Return to Sport Protocol.

□Concussion/Head Injury Resolved. Athlete is medically eligible to Return to Play on this date: _________________.

** This option means that the doctor says your child is ready to return to play and the date provided is the day that your child can return to play - meaning return to all practices (sports and strength and conditioning) and games.

 

Return to Learn

Stage 1: No School "Cognitive Rest"

Stage 2: School Part Time - Maximum Adjustments

  • Up to Half Day attendance with appropriate academic adjustments

  • No homework or testing

Stage 3: School Part Time - Moderate Adjustments

  • Full Day attendance with appropriate academic adjustments

  • Limited homework (does not cause symptoms to return), no testing

Stage 4: School Part Time - Minor Adjustments

  • Full day attendance with no academic adjustments

Stage 5: Full Time School with no special accommodations

If signs/symptoms persist, further evaluation by the concussion care team and accommodations by the academic institution must be made. The key is for everyone to be on the same page!

*Suggested accommodation strategies for cognitive problems. See p. 7

*See this chart for the stages of Return to Learn

 

Return to Play After Concussion = "Graduated Return to Sport"

  • An initial period of 24–48 hours of both relative physical rest and cognitive rest is recommended before beginning the RTS progression.

  • There should be at least 24 hours (or longer) for each step of the progression. If any symptoms worsen during exercise, the athlete should go back to the previous step. Resistance training should be added only in the later stages (stage 3 or 4 at the earliest). If symptoms are persistent (e.g., more than 10–14 days in adults or more than 1 month in children), the athlete should be referred to a healthcare professional who is an expert in the management of concussion.

Stage 1

Aim: Symptom-limited activity

Activity: Daily activities that do not provoke symptoms

Goal: Gradual reintroduction of work/school activities

Stage 2

Aim: Light aerobic exercise

Activity: Walking or stationary cycling at slow to medium pace. No resistance training

Goal: Increased heart rate

Stage 3

Aim: Sport-specific exercise

Activity Running or skating drills. No head impact activities

Goal: Add movement

Stage 4

Aim: Non-contact training drills

Activity: Harder training drills, e.g. passing drills. May start progressive resistance training.

Goal: Exercise, coordination/thinking

Stage 5

Aim: Full contact practice

Activity: Following medical clearance, participate in normal training activities

Goal: Restore confidence and assess functional skills by coaching staff

Stage 6

Aim: Return to Sport

Activity: Normal game play

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