Returning to Play After a Concussion

Nancy Harris Bonk Health Guide
  • Concussion, headaches, and other results of sports injuries aren't just health issues - they're added frustrations for athletes. The first thing any athlete wants to know immediately after they've been injured is when they will be able to return to play. For most, a strained muscle or broken limb will heal within a few days or weeks and they'll be back the game. However, if a player sustains concussion or traumatic brain injury (TBI) it may be a different story. Recovery from a TBI for the majority of players will take only a few days. But for some, it may take much longer. Correctly managing an athlete with a TBI is extremely important; proper physical and cognitive rest is imperative; or until concussive symptoms subside. If a concussed athlete returns to play too soon, their symptoms may recur and persist, prolonging their recovery.

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    Typically, the treatment for a concussed player is basically the same - no physical work that makes any symptom worse; no yard work, no house work, no weightlifting or other activity that's physically demanding, not even recreational activities, such as skateboarding. No cognitive or visual stimulation including TV, video games, texting, cell phones, reading or anything else that overly stimulates the brain. Getting lots of sleep and extra rest are imperative during the early stages of concussion recovery. If, after 10-14 days, the player finds their symptoms have not gone away or are becoming worse, or if the player has other conditions such as Migraines, depression, anxiety, mood disorders or multiple concussions, it is time to consult a doctor who specializes in concussion.


    When an athlete is no longer symptomatic for at least 24 hours, only then is he ready to begin the steps to reenter the game. The Centers for Disease Control and Prevention (CDC) now has clear-cut guidelines that doctors, coaches, trainers and parents can use to gauge when athletes can get back into play safely. It's called the "Return to Play Progression."

    • The first step is having complete physical and cognitive rest and no longer having any concussion symptoms for at least 24 hours. Conservative treatment is a must when treating a younger athlete.
    • The athlete can then move on to light aerobic exercise where the only goal is to increase the heart beat for about 5 - 10 minutes. Using an exercise bike, walking or light jogging is acceptable, but there is to be no weight lifting, hard running or jumping of any kind.
    • Next, the player can move on to moderate exercise with limited body and head movement, but must not to exceed typical workout routine time. Now the player can do moderate jogging, moderate-intensity exercise biking, and moderate-intensity weightlifting and brief running.
    • Next is moving to non-contact exercise that is more intense but still no contact. The player can exercise close to their "normal" routine and can include running, high intensity exercise biking, their "normal" weightlifting regime and non-contact sport-specific drills. Cognitive components of the game may now be added at this stage.
    • Return to practice with full contact.
    • The last step is returning to competition.

    As the player progresses from each step, he/she is carefully monitored for any recurring physical and cognitive symptoms. If the player becomes symptomatic at any one stage, the progression is immediately stopped. The player rests for at least 24 hours or until he is no longer symptomatic. Then the player starts on the previous step before his symptoms returned. Ideally, each step is monitored by a health professional who knows the player's ability. Some athletes will complete these steps in one day and be on back in the game in no time. Yet for others, it may take days, weeks, or even months to complete this progression being symptom-free. A conservative approach is best used with a young athlete.


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    Every athlete wants to play regardless of the injury - hearing the phrases "tough it out," "suck it up," "take one for the team," throughout their training. Getting back into the game correctly, benefits the entire team and individual athlete as well. A team is only as strong as its least healthy player. Injured players make mistakes, mistakes create more injuries. Play it safe, strong and healthy, and when you are ready, get back into the game.




    Sugerman, David. M.D. M.P.H. "Hey Doc, When Can I Return to Play? A Heads-Up on Managing Concussion in Sports." Medscape News Today. November 28, 2011.


    McCroy, P.; Meeuwisse, W.; Johnston, K.; Dvorak, J.; Aubry, M.; Molloy, M.; Cantu, R. "Consensus Statement on Concussion in Sport: the 3rd International Conference on Concussion in Sport." British Journal of Sports Medicine 2009; 43:i76-i84 doi: 10 1136/bjsm.2009.058248. Zurich, November 2008.


    Information sheet. "A "Heads Up" on Managing Return to Play." Centers for Disease Control and Prevention. CDC's Injury Center. Prevention and Control: Traumatic Brain Injury. Last updated December 15, 2011.


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    © HealthCentral Network, 2012.
    Last updated January 17, 2012.

Published On: January 17, 2012