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Returning to High School Sports following a Concussion

Written by Alex Salinas MS, AT, ATC
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AlexSalinasThe internet contains an abundance of information about concussions.  This information ranges anywhere from educational and useful to sensationalized and misleading.  I am not writing this post to tell you about how to identify a concussion or what the signs and symptoms are.  The goal of today’s post is to provide some enlightenment on return-to-participation (RTP) protocols.  In my experience, there is less push back from parents, student-athletes, and coaches in the identification of concussions and more push back regarding the return date.  I believe this resistance is due in part to confusion given the number of changes and updates in policy over the past five years.

Please note concussions are handled on a case-by-case basis, and a portion of concussions involve academic modifications. For the sake of this post, we will assume the student-athlete has fully returned to school without recurrence of symptoms.

Once symptoms have resolved, the RTP protocol is initiated.  Please note that low-intensity aerobic exercise may be recommended by a physician in prolonged cases where low-grade symptoms are lingering to facilitate healing.

The National Federation of State High School Associations and the Michigan High School Athletic Association (MHSAA) support the implementation of a gradual RTP protocol (example below)

Step 1:  light exercise (i.e. cycling or walking), 15-20:00* 

Step 2:  sport-specific activities without the threat of contact from other people or objects (i.e. straight-line running, shooting, throwing), >30:00

Step 3:  noncontact training involving others (cone drills, plyometrics, weightlifting), >45:00^

Step 4:  unrestricted training (i.e. full practice)%

Step 5:  full return to gameplay#

*If symptoms reappear or worsen at any step, cease activity and repeat the step ≥24 hours later

^Exercises from the first two steps may be incorporated to increase duration of activity

%Cannot progress to this step until unconditional release by MD, DO, PA, or NP

#Satisfactory scores on a neurocognitive test such as ImPACT may also be required by your school

Evidence-based reasoning behind the gradual return can be found here.

Per the MHSAA, clearance must be unconditional and signed by a parent/guardian and the student-athlete.  This form available here. This is then forwarded to the MHSAA to maintain compliance.

GettyImages 153522182Closing Notes

The clearing physician may send one clearance to begin the RTP protocol and a second clearance once the student-athlete has progressed through Step 3.

Projecting return dates is an undesirable habit.  Some people return quickly (10-14 days from injury date), while others may several weeks or months.  This varies from person to person and even case to case in the same person.

As an athletic trainer, my goal is to promote the health, safety, and well-being of the student-athletes I work with.  The timing of injuries can be cruel.  Concussions do not have “wiggle room” like other injuries. A blister can be protected or a finger can be splinted to keep someone in action for a while longer.  We only have one brain, and at the end of the day that is more important than a win or a loss.

There are numerous variables that affect healing and many people that are involved with a successful return to normal activity; constant communication is crucial.


MHSAA Health and Safety – Heads


MHSAA Protocol Summary


MHSAA Concussion Insurance Policy Information


Michigan’s Sports Concussion Laws


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