Concussion Return to Play: Step-By-Step Approach Recommended

The 2nd International Conference on Concussion in Sport held in Prague in 2004 (Prague consensus statement) recommends a step by step approach to return to play after sports concussions, recommending that athletes:

• Not be allowed to return to play in the current game or practice even if the symptoms quickly disappear (Note that this is more conservative approach than other return-to-play guidelines);

• Be evaluated by a doctor;

• Not be left alone (regular monitoring for signs of deteriorating mental status is essential over the first 24 to 48 hours following a suspected concussion).

• Not drive a motor vehicle.

Once an athlete is symptom-free he should not be allowed to return to play sports until he has completed the following medically supervised stepwise process:

1. No activity, complete rest (for youth athletes, complete rest includes cognitive rest, i.e. no school or doing homework). Once an athlete is completely 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, ideally only after clearance by a medical doctor;

6. Game play.

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

Some experts, including MomsTeam's concussion expert, Dr. Robert Cantu, feel the Prague return-to-play protocol should apply only where an athlete has suffered a "complex" concussion. Athletes who suffer "simple" concussions can be allowed to return to play within a week.