Not A Badge Of Courage

Most recent return to play guidelines

When a child shows any symptoms or signs of a concussion, the most recent consensus of experts at the 2nd International Conference on Concussion in Sport held in Prague in 2004 is that:

• The player should not be allowed to return to play in the current game or practice (this is a much more conservative approach than other return-to-play guidelines would have allowed and essentially reflects the philosophy "When in doubt, sit out.");

• The player should not be left alone - regular monitoring for deterioration is essential over the first few hours following injury;

• The player should be evaluated by a doctor;

• The player should not be allowed to return to play until he has completed the following medically supervised stepwise process:

1. No activity, complete rest. Once symptom free, proceed to step 2;

2. Light aerobic exercise such as walking or stationary cycling, no resistance training;

3. Sport specific training (i.e. skating in hockey, running in soccer);

4. Non-contact training drills;

5. Full contact training after medical clearance;

6. Game play.

• If any post-concussion symptoms reoccur, drop back to previous asymptomatic level and try to progress again after 24 hours.

Because activities that require concentration and attention may exacerbate the symptoms and delay recovery, you should try to limit your child's day-to-day and school-related activities until he is symptom free. It is therefore important to emphasize to your child the need for complete physical and cognitive rest in the first few days following a traumatic brain injury. This means no homework and staying home from school.

The most recent consensus of experts is that athletes who have suffered multiple concussions should be held out of play for an extended period of time (around a week) after symptoms have cleared, especially during the same sports season. For athletes who have suffered three mild/simple concussions or two moderate-severe/complex concussions in the same season, experts advise that they not be permitted to return to play again that season.

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Article Updated: August 1, 2007

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