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No Same Day Return To Play After Concussion

International Consensus Statement Urges Conservative Approach for Youth Athletes

The most recent international consensus of concussion experts1 is that a young athlete with diagnosed concussion should not be allowed to return to play on the day of injury, regardless of the medical resources available and regardless of the level of athletic performance (in other words, even if an "elite" athlete).  The recommendation has now become a legal mandate under the concussion safety laws of nearly every state.

Settled matter

Until recent years, there was still significant controversy over whether an athlete should be allowed to return to play on the day of injury.  Most older (pre-2000) guidelines, now abandoned, would permit an athlete to return to the same contest or practice if he has been symptom free for at least 15 to 20 minutes and it is his first concussion of the season (no RTP if second concussion).  All concussion guidelines issued in the last 10 years, and by law in most states, bar same day return to play if a player displays any post-concussion signs or symptoms.

Current concussion guidelines, such as the Zurich consensus statement, also recomend following a step-wise return-to-play protocol and take a more individualized approach utilizing progressive aerobic and resistance exercise challenge tests, consideration of so-called modifying factors (e.g. the severity of the current injury, the number, severity, and proximity in time of previous concussions, whether the concussion was a result of a minor blow, age, sport, and the athlete's learning disabilities, such as attention deficit disorder (ADD) or attention deficit hyperactivity disorder (ADHD)).

Different guidelines for youth athletes

The Zurich consensus statement continues to emphasize the concept of "cognitive rest" first introduced as an additional concussion management requirement for children in the 2nd Consensus Statement issued in 2004.  Because activities that require concentration and attention might exacerbate the symptoms and delay recovery, the statement recommends that child limit exertion with activities of daily living and limit school-related activities until symptom free (e.g. no homework, no text messaging, videogames and staying home from school).

The statement also recognized (a) that additional research was needed to better clarify the potential differences between adults and children with regard to recovery from concussion injury, and to develop cognitive assessment tools that better evaluate the young athlete, and (b) that it may be appropriate to extend the amount of time of asymptomatic rest and/or the length of the graded exertion in children and adolescents because of the "different physiological response during childhood to head trauma."

1. McCrory P, et al. Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport held in Zurich, November 2012 Br.J. Sports Med. 2013: 47:250-258.

Updated and most recently revised December 1, 2014