Returning to Play (Sports and Recreation) after a Mild TBI
Guiding the recovery of individuals of any age with MTBI who participate in competitive or recreational activities requires careful management to avoid re-injury or prolonged recovery. Athletes engaged in collision sports require special management and evaluation to ensure full recovery prior to their return to play.
It is important to monitor symptoms and cognitive function carefully during each increase of exertion. Athletes should only progress to the next level of exertion if they are not experiencing symptoms at the current level.
If symptoms return at any step, an athlete should stop these activities as this may be a sign the athlete is pushing too hard. Only after additional rest, when the athlete is once again not experiencing symptoms for a minimum of 24 hours, should he or she start again at the previous step during which symptoms were experienced.
The Return to Play Progression process is best conducted through a team approach and by a health professional who knows the athlete’s physical abilities and endurance. By gauging the athlete’s performance on each individual step, a health care professional will be able to determine how far to progress the athlete on a given day. In some cases, the athlete may be able to work through one step in a single day, while in other cases it may take several days to work through an individual step. It may take several weeks to months to work through the entire 5-step progression.
Some policies may require health care professionals to take a training program or provide written clearance as part of the return to play process for young athletes.
Remember, while most athletes will recover quickly and fully following a concussion, some will have symptoms for weeks or longer. Health care professionals should consider referral to a concussion specialist if:
- the symptoms worsen at any time,
- symptoms have not gone away after 10-14 days, or
- the patient has a history of multiple concussions or risk factors for prolonged recovery. This may include a history of migranes, depression, mood disorders, or anxiety, as well as developmental disorders such as learning disabilities and ADHD.