Protocol for Return to Play
Return to play following a concussion involves a stepwise progression once the individual is symptom free. There are many risks to premature return to play including: a greater risk for a second concussion because of a lower concussion threshold, second impact syndrome (abnormal brain blood flow that can result in death), exacerbation of any current symptoms, and possibly increased risk for additional injury due to alteration in balance. These New York State Public High School Athletic Association (NYSPHSAA) current return to play recommendations are based on the most recent international expert opinion.
- No student athlete should return to play while symptomatic.
- Students are prohibited from returning to play the day the concussion is sustained.
- If there is any doubt as to whether a student has sustained a concussion, it should be treated as a concussion.
- Once the student athlete is symptom free at rest for 24 hours and has a signed release by the treating clinician, she/he may begin the return to play progression below initiated and monitored by the school nurse (provided there are no other mitigating circumstances).
Phase 1: low impact, non-strenuous, light aerobic activity such as walking or riding a stationary bike. (5-10 mins.) If tolerated, without return of symptoms over a 24 hour period proceed to:
Phase 2: higher impact, higher exertion, and moderate aerobic activity such as running or jumping rope. (15-20 mins.) No resistance training. If tolerated, without return to symptoms over a 24 hour period proceed to:
Phase 3: sport-specific/PE-specific non-contact activity, moderate to high intensity. (30 mins.) Low resistance weight training with a spotter is acceptable. If tolerated, without return to symptoms over a 24 hour period proceed to:
Phase 4: full contact training drills and intense aerobic activity, full PE class activities. If tolerated, without return to symptoms over a 24 hour period proceed to:
Phase 5: Return to full activities with no restrictions.
Each phase of the return to play can be done during PE classes, during team practice, before or after school and during lunch or free period with the appropriate personnel. Clear and concise communication should take place between teachers/coaches/athletic trainer and the nurse’s office.
If a student is not symptom free during the 24 hour period following a phase, the return to play is suspended until the student is symptom free for 24 hours. Once the student is symptom free return to the last phase and continue on with the return to play protocol.
The Concussion Management and Awareness Act requires the immediate removal from athletic activities of any pupil believed to have sustained or who has sustained a mild traumatic brain injury (concussion). In the event that there is any doubt as to whether a student has sustained a concussion, it shall be presumed that he or she has been so injured until proven otherwise. No such student shall resume athletic/physical activity until he or she shall have been symptom free for not less than twenty-four hours, and has been evaluated by and received written and signed authorization from a licensed physician. The physician authorization will then be forwarded to the School Nurse for clearance and the initiation of the return to play protocol will commence.