Daily Bolus of LR: Return to play after a concussion

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September 30, 2011 by dailybolusoflr

Return to play after a concussion


Patients present to the ED frequently after sports related head injuries and many of them are diagnosed and discharged with the diagnosis of a concussion.  There is little guidance for EM practitioners regarding return to play guidelines for us to give patients.  Many of the official guidelines from sports related organizations depend upon long term follow up and baseline neuro-cognitive testing and are not particularly useful in our area of practice.


I do want to point out that many of the new guidelines have begun to support a gradual entrance program for athletes who have sustained a concussion.  While in the past we have simply told patients they could return in 1-2 weeks, there have been recent supporters of a more gradual program which allows patients to take a stepwise approach to re-entering the sport.  The following is an example:


Stepwise return to play

a. No activity and rest until asymptomatic at rest

b. Light aerobic exercise such as walking or stationary bike

c. Sport-specific training (running in soccer or skating in hockey)

d. Noncontact drills

e. Full-contact drills

f. Game play


For each level until full game play, one would remain at that level until they could participate without the occurrence of symptoms.  Successful completion of each step would allow for a step a day and would have an athlete returning to play in under a week if all went well.


Most also agree that children should NEVER be allowed to return to play the same day as an injury.


Ref: Clin Sports Med 23 (2004) 421– 441 and Br J Sports Med 2009;43:i51-i55

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