Houston Methodist. Leading Medicine.
Houston Methodist. Leading Medicine

Houston Methodist Concussion Center

Returning to Play

Return to Play Procedures Following Concussion

The athlete must meet all the following criteria in order to progress to activity:

  • Asymptomatic at rest and with exertion (including mental exertion in school)
  • Asymptomatic with light contact
  • Demonstrate normal scores on cognitive assessment (e.g., ImPACT test) as determined by the neuropsychologist

Once the above criteria are met, the athlete can progress back to full activity following a stepwise progression, preferably under the supervision of an athletic trainer.

Progression is individualized, and will be determined on a case by case basis. Factors that may affect the rate of progression include: acute markers of injury (e.g., LOC, amnesia), previous history of head injury/concussion, duration and type of symptoms, age of athlete, and sport or activity in which the athlete participates.

An athlete with a prior history of concussion, one who has had an extended duration of symptoms, or one who is participating in a collision or contact sport may be progressed more slowly.

Gradual Return To Play Protocol

Rehabilitation Stage

Functional Exercise at
Each Stage of Rehabilitation

Stage Objective

No activity

Complete physical and cognitive rest

Recovery

Light aerobic exercise

Walking, swimming or stationary cycling keeping
intensity, 50-70% MPHR; no resistance training

Increase HR

Sport-specific exercise

Skating drills in ice hockey, running drills in soccer;
no head impact activities 60-75% MPHR

Add movement

Non-contact training drills

Progression to more complex training drills, eg,
passing drills in football and ice hockey; may
start progressive resistance training  80+% MPHR

Exercise, coordination
and cognitive load

Full contact practice

Following medical clearance, participate in normal training activities

Restore confidence. Assess functional skills

Return to play

Normal game play

HB 2038 known as Natasha’s law wassigned into law June 20th 2011 by Governor Rick Perry and became effective September 1. Because of this all public school districts must establish a return to play protocol developed by their concussion oversight team (COT). It is important to recognize that progression of return to play is individualized, and should be determined on a case by case basis. Factors that may affect the rate of progression include: acute markers of injury (e.g., LOC, amnesia), previous history of head injury/concussion, duration and type of symptoms, age of athlete, and sport or activity in which the athlete participates. An athlete with a prior history of concussion, one who has had an extended duration of symptoms, or one who is participating in a collision or contact sport may be progressed more slowly.

  • The bill mandates a Concussion Oversight Team chosen by each school district or charter school, headed by at least one physician with concussion management training. If the school district employs an athletic trainer, the athletic trainer must be a member of the district or charter school concussion oversight team.
  • The bill defines who the Licensed Health Care Professionals are that will participate in the development and implementation of the concussion oversight team in schools. This includes advanced practice nurses, athletic trainers, neuropsychologists, physicians or physician assistants.
  • The bill will require the UIL to provide a document, to be signed, to inform the students and parents of the dangers of sports concussions.
  • The bill requires students who are suspected of sustaining a concussion be removed from activity/play immediately.
  • The athlete must be evaluated for the suspected concussion by a physician of his/her choosing.
  • When the student athlete is suspected of suffering a concussion; the student athlete, parents or guardian, and other appropriate school employees must receive a written copy of the concussion oversight team’s protocol for the student’s return to play and practice.
  • Upon completion of the school district’s concussion oversight team’s return to play protocol, the treating physician must sign a written statement indicating that, in their professional judgment, it is safe for the student to return to play.
  • If the school district or charter school employs an athletic trainer, he/she is responsible for the compliance of the athlete with the return to play protocol.
  • A coach of an interscholastic athletics team may not authorize a student’s return to play.
  • The bill establishes concussion education for coaches must be met every two years. The UIL must approve the continuing education for coaches and the education must be at least two hours. Requirements in concussion management for athletic trainers which can be met in the two year cycle must be approved by The Department of State Health Services Advisory Board of Athletic Trainers. Concussion education is also required for licensed health care professionals and recommended for physicians.
  • The bill provides for immunity from liability for school districts or members of the concussion oversight team complying with this act.

Returning To The Classroom

Reintegrating back into classes can be tricky. Brain dysfunction can linger. When an athlete is returns back to exercising, it does not equal back to normal. 

How Can Teachers Help?

  • Be alert to concussed student
  • Remove from class if needed
  • Work with and support student and school team with a slow reintegration
  • Be vigilant to emotional factors:
    • stress, fear of failing, depression, over-achieving etc
  • Need for IEP or modify existing IEP?
  • Be part of the team: This includes the student, parents, other teachers, athletic trainers, nurses, school administration and health-care provider

See links below to articles for more information on returning to the classroom:

  • Supporting the student-athletes return to the classroom after a sports-related concussion Print Flyer
  • CDC – Returning to school after a concussion: A fact sheet for school professionals Print Flyer