Treatment & Procedures

Most athletes who experience an initial concussion can recover completely as long as they do not return to contact sports too soon. Following a concussion, there is a period of change in brain function that may last anywhere from 24 hours to 10 days and in some cases longer. During this time, the brain may be vulnerable to more severe or permanent injury. If the athlete sustains a second concussion during this time period, the risk of permanent brain injury increases.

The first step in recovering from a concussion is rest. Rest is essential to help the brain heal. Students with a concussion need rest from physical and mental activities that require concentration and attention as these activities may worsen symptoms and delay recovery. Exposure to loud noises, bright lights, computers, video games, television and phones (including texting) all may worsen the symptoms of concussion. As the symptoms lessen, increased use of computers, phone, video games, etc., may be allowed.

Athlete must show no signs of post-concussion symptoms for 1-3 consecutive days without medication before return to play protocol begins.  The athlete will progress only one stage each day (24 hours).

Using the Houston Methodist Concussion Documentation Form it is important to do a symptom check with the athlete after they have completed each stage.

Stage 1 - Light aerobic exercise with no resistance training (50-60% of MHR)
10-15 minutes (e.g., walking, stationary bike, and hand bike low intensity setting)

Stage 2 - Moderate aerobic activity with resistance training (60% - 70% of MHR)
20-25 minutes (e.g., running, light weights – No squat, dead lift or bench press)

Stage 3 – Sport specific activity and non-contact training drills. Heavy exertion (70%-80% of 
MHR) 25-30 minutes (non-contact training or non-contact practice

Stage 4 - Full practice including light contact activities (e.g., head balls in soccer, sleds football)

Stage 5 - Full Practice – Full Contact

Stage 6 - Return to full participation (pending physician clearance) 

MHR (Maximum Heart Rate) = 220 – Athlete’s age

*If concussive symptoms occur during or after activity, the athlete should stop all activity until symptom free for 24 hours. Athlete may resume with phase in which they were previously symptom free.

Please note if a physician note is received that requires the athlete to be in a stage longer than one day that must be followed.

Below are lists of signs and symptoms to watch for if you suspect an injury that may have resulted in a concussion. If your experience one or more symptoms listed below, you should seek medical attention immediately.

Observable Signs

• Appears dazed or stunned
• Confused about assignment or position
• Forgets an instruction
• Unsure of game, score or opponent
• Moves clumsily
• Answers questions slowly
• Loses consciousness (evenly briefly)
• Shows mood, behavior and personality changes
• Cannot recall events prior to hit or fall
• Cannot recall events after hit or fall
• Loses balance or is unsteady when walking

Symptoms Reported by Athlete

• Headache or feeling pressure in head
• Nausea or vomiting
• Balance problems or dizziness
• Double or blurry vision
• Sensitivity to light or noise (too bright or too noisy)
• Feeling sluggish, hazy, foggy or groggy
• Concentration or memory problems
• Confusion
• Just not "feeling right" or is "feeling down"

Be alert for symptoms that worsen over time. If you experience more serious symptoms, such as those listed below, go to the emergency department right away.

More Serious Observable Signs

• One pupil (the black part in the middle of the eye) is larger than the other
• Drowsiness or cannot be awakened
• Headache that gets worse and does not go away
• Weakness, numbness or decreased coordination
• Repeated vomiting or nausea
• Slurred speech

More Serious Symptoms Reported by Athletes

• Convulsions or seizures
• Difficulty recognizing people or places
• Increasing confusion, restlessness or agitation
• Unusual behavior
• Loss of consciousness (even a brief loss of consciousness should be taken seriously)