When can a student athlete return to play after a concussion?

Student athletes are ready to return to play when they are:

  • 100% symptom free at rest.
  • 100% symptom free with normal mental activity.
  • 100% symptom free with exercise.
  • No longer taking any medications for concussion symptoms.
  • Fully back to school and able to tolerate school work.

And

  • Have a post-concussion neurocognitive test (ImPACT or other symptom and assessment tool) score that is at least as good as the pre-concussion score or pass certain criteria set by the school or athletic board.
  • Have a physical exam and balance test that are within normal limits.
  • Have been cleared for play by a healthcare provider trained in evaluating and managing concussions.

The thinking used to be that the student athlete needed to be symptom free for 24 hours before starting the multiphase process of physical activity toward the goal of returning to play. However, research has now shown that if the patient’s concussion symptoms are improving each day and they are able to attend a full school day with a few breaks for symptoms, they can begin to add very low level cardiovascular activities. These activities should consist of walking or biking on a stationary bike at an intensity that doesn’t make symptoms worse.

With the help of an athletic trainer or physical therapist, athletes can begin to increase their activity level each day, making sure they can tolerate increasing how hard they exercise over time without triggering symptoms before moving on. For example, start out slow with aerobic exercise, then move on to sport-specific drills, then contact activities and finally full participation. This step up in activity can take up to 10 days or longer, as each increase in activity may bring on symptoms and require rest and return to the previous step.

Following this approach, most student athletes are able to return to play within about three weeks after their symptoms began.

What can happen if an athlete who had a concussion returns to competition too soon?

Returning to competition too soon could put you at risk for a second concussion. A repeat concussion that occurs before your brain has recovered from a first one is called second impact syndrome.

Second impact syndrome can:

  • Make your symptoms last longer than they would have if you rested and fully recovered.
  • Slow your overall recovery.
  • Increase the chances for long-lasting or permanent problems.

Long-lasting problems include difficulties with concentration and memory, headaches, and sometimes physical skills like maintaining your balance. Although this is rare, returning to competition without being fully recovered and getting hit again could result in a brain hemorrhage or even death. Never return to competition until ALL your symptoms are gone and you feel you are 100% back to your normal self.

If an athlete has a concussion, how likely are they to have another one?

Once you’ve had a concussion, you are three to five times more likely to have another concussion. The highest risk is for those who return to competition before their symptoms have completely gone away. No one should return to active play if they are still having symptoms from a concussion.

What are the long-term complications of concussion?

Long term complications of concussion include:

  • Post-concussion syndrome. This is a condition in which you experience concussion symptoms for weeks or even months (instead of days) after experiencing a concussion. Such symptoms may include ongoing dizziness/spinning, headache, memory and concentration problems, mood swings, depression, anxiety, irritability, personality changes, insomnia (can’t sleep) and excessive drowsiness.
  • Higher risk of anxiety and depression (especially if there’s been multiple concussions).
  • Structural brain injuries from multiple concussions. People who have had several head injuries in their life are at higher risk of long-lasting impairment. Chronic traumatic encephalopathy is one example of a brain condition linked to repeated blows to the head.
  • Problems with memory, naming and word-finding.
  • Dementia.

Anyone who has symptoms that won’t go away or that are worsening seen be seen by their healthcare provider.

Are mild concussions serious?

Even if you’ve been told that you’ve only experienced a “mild concussion,” all concussions should be considered serious events. In most cases it’s true that a single concussion is unlikely to cause permanent brain damage. However, even having a mild concussion puts you at an increased risk of another concussion. In addition, if you were to experience another concussion before your concussion symptoms have fully gone away, you could be at greater risk of permanent damage or even death if you have another concussion.

Are concussions fatal?

It’s rare, but a concussion can lead to bleeding in the brain or brain swelling that can be fatal. This is one of the reasons why it’s so important to carefully watch a concussed person in the first 24 to 48 hours after the concussion and to seek immediate care if symptoms worsen.

Are there any cures for concussion besides rest?

There is no doubt that rest helps a brain recover from a concussion. There is research going on to determine how much rest is needed, but each concussion is treated individually. Typically, mental and physical rest is advocated. There is also research going on looking at medications that may be useful to prevent the progression of concussion, based on the physiology of what happens when the brain is initially concussed, and to help the brain "heal" more quickly.

Last reviewed by a Cleveland Clinic medical professional on 06/02/2020.

References

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy