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What Does Return to Play Really Mean?

Understanding Post-Concussion Protocol

Concussions affect every aspect of a student athlete’s life on and off the field. As such, they can be overly eager to return to sports – not to mention school or their social life – before they’ve properly recovered. But recovery is a gradual process; recognizing the symptoms and understanding the return protocol is essential to concussion care.

“Our efforts to educate and inform parents, coaches, administrators and clinicians about concussions are paying off. More and more athletes are self-reporting, but there’s still so much we don’t know. Use common sense and err on the side of caution,” says Brian Babka, MD, a sports medicine physician at Northwestern Medicine. “Any suspected head injury should be taken seriously: When in doubt, keep them out. That means no same day return to play.”

The return to learn and return to play protocols used by many Illinois schools, park districts and club teams are in place to protect student athletes, even from their own enthusiasm.

Here’s what they mean and how to follow them:

When to Return to Learn

Many of the immediate signs of concussion – such as headache, dizziness, drowsiness and lack of focus – can impact academic performance. But missing multiple days of school can create a backlog of assignments and learning. Many schools have concussion oversight teams who work with parents, school counselors, school nurses and teachers to help student athletes transition back to class, as the student is ready.

“We all need to work together to help a student athlete recover. Cocooning a student from school can cause anxiety, depression and frustration from trying to catch up on assignments, so using a step-by-step approach is imperative,” says Babka.

The 5-Step Return to Play Process

Once the student is able to return to regular school activities for 24 hours without any symptoms, and has received the green light from a healthcare provider, the five-step return to play progression can begin. Since 2015, all schools must follow return to play protocol as mandated by Illinois legislation in the Youth Sports Concussion Safety Act. The athlete needs to be symptom-free before moving on to the next step.

The five steps, as outlined by the Centers for Disease Control, are as follows:

  1. Light aerobic activity, such as five to 10 minutes on a stationary bike or walking
  2. Moderate activity that increases an athlete’s heart rate with body or head movement, such as light jogging
  3. Heavy, non-contact activity such as non-contact sport-specific drills, weightlifting or high-intensity stationary biking
  4. Practice and full contact drills
  5. Games and competition

“The full progression can take five days or more. It’s up to the athlete to self-report any symptoms, and the athletic trainer and coach should supervise each step,” says Babka.

After Back in Action

The science of concussions continues to evolve, and there is still much to learn about the long-term effects. Multiple traumatic brain incidents contribute to the development of mild cognitive impairments and other adverse outcomes.

However, it’s important to remember sports are not the enemy: “We want kids to be active, and the long-term benefits of physical fitness far outweigh the risks,” says Babka, who treats concussions through the Sports Concussion Clinic at Central DuPage Hospital and Delnor Hospital. “Furthermore, proper recovery can prevent against neurologic damage in subsequent concussions.”