Concussion Management

If an athlete is suspected of having a concussion, he or she must be immediately removed from play, be it a game or practice. Continuing to participate in physical activity after a concussion can lead to worsening concussion symptoms, increased risk of further injury, and even death. Parents and coaches are not expected to be able to “diagnose” a concussion, as that is the job of a medical professional, however, you must be aware of the signs and symptoms of a concussion and if you are suspicious, then your child must stop playing:

All athletes who sustain a concussion need to be evaluated by a healthcare professional who is familiar with sports concussions. You should call your child’s physician and explain what has happened and follow your physician’s instructions. If your child is vomiting, has a severe headache, is having difficulty staying awake or answering simple questions, he or she should be taken to the emergency department immediately

After suffering a concussion, no athlete should return to play or practice on the same day. Previously, athletes were allowed to return to play if their symptoms resolved within 15 minutes of the injury.  Studies have shown us that the young brain does not recover quickly enough for an athlete to return to activity in such a short time. 

Once an athlete no longer has symptoms of a concussion and is cleared to return to play by a healthcare professional knowledgeable in the care of sports concussions he or she should proceed with activity in a stepwise fashion to allow the brain to re-adjust to exertion. On average the athlete will complete a new step each day. The return to play schedule should proceed as below following medical clearance:

• Step 1: Light exercise, including walking or riding an exercise bike. No weight lifting.
• Step 2: Running in the gym or on the field. No helmet or other equipment.
• Step 3: Non-contact training drills in full equipment. Weight-training can begin.
• Step 4: Full contact practice or training.
• Step 5: Game play

If symptoms occur at any step, the athlete should cease activity and be re-evaluated by their health care provider.

Following a concussion, many athletes will have difficulty in school. These problems may last from days to months and often involve difficulties with short and long-term memory, concentration, and organization.  In many cases it is best to lessen the athlete’s class load early on after the injury. This may include staying home from school for a few days, followed by a lightened schedule for a few days, or perhaps a longer period of time, if needed. Decreasing the stress on the brain early on after a concussion may lessen symptoms and shorten the recovery time.

Both you and your child should learn to recognize the “Signs and Symptoms” of concussion as listed in this packet

• Teach your child to tell the coaching staff if he or she experiences such symptoms.
• Emphasize to administrators, coaches, teachers, and other parents your concerns and expectations about concussion and safe play.
• Teach your child to tell the coaching staff if he or she suspects that a teammate has a concussion.
• Monitor sports equipment for safety, fit, and maintenance.
• Ask teachers to monitor any decrease in grades or changes in behavior that could indicate concussion.
• Report concussions that occurred during the school year to appropriate school staff. This will help in monitoring injured athletes as they move to the next season’s sports.

Any athlete even suspected of suffering a concussion should be removed from the game or practice immediately. No athlete may return to activity after an apparent head injury or concussion, regardless of how mild it seems or how quickly symptoms clear. Close observation of the athlete should continue for several hours.

An athlete who is suspected of sustaining a concussion or head injury in a practice or game shall be removed from competition at that time and may not return to play until the athlete is evaluated by the school's certified athletic trainer and/or medical doctor or doctor of osteopathy that is specifically trained in the management of concussion. The athlete must receive written clearance to return to play from that healthcare provider and must have completed the TJHS concussion return to play progression as supervised by the athletic trainer. We follow a stepwise activity progression based on recommendation in the Zurich Consensus Statement from the 3rd International Congress on Concussion in Sports as follows:

• Step 1: Light aerobic exercise (i.e. stationary bike, elliptical machine)
• Step 2: Moderate aerobic exercise (begin running program)
• Step 3: Functional exercises (increase running intensity, begin agilities, non-contact sport-specific drills)
• Step 4: Non-contact practice activities
• Step 5: Full contact practice activities.
• Step 6: Full game play

Each step is separated by 24 hours. If any symptoms occur, the athlete will drop back to the previous level and try to progress again after 24 hours of rest has passed. You should also inform your child’s Coach, Athletic Trainer (ATC), and/or Student Activities Director, if you think that your child/player may have a concussion.  For current and up-to date information on concussions you can go to: www.cdc.gov/ConcussionYouthsSports/ or www.nfhslearn.com (Information was provided by the National Federation of High School Sports.)