Don’t Rush the Return: Why Concussion Protocols Matter in Sports

Concussions have become one of the most talked-about injuries in sports at every level—from youth leagues to professional play. While many athletes and parents once brushed off a “mild head knock,” science now shows us that concussions are brain injuries that must be taken seriously. Recognizing the signs, managing the recovery, and following the proper return-to-play (RTP) protocol are essential for both short-term health and long-term well-being.

What Is a Concussion?

A concussion is a type of traumatic brain injury (TBI) caused by a blow or jolt to the head—or even a hit to the body that causes the brain to move rapidly inside the skull. This sudden movement can disrupt normal brain function, leading to symptoms that may appear immediately or develop hours later.

Common symptoms include:

• Headache or “pressure” in the head
• Nausea or vomiting
• Impaired balance
• Dizziness and light headedness
• Blurry or double vision
• Sensitivity to light or noise
• Feeling slow, foggy, or groggy
• Difficulty with concentration/memory
• Sleep disturbance
• Mood or behavior changes

Not every concussion looks the same, which is why medical evaluation is so important.

The Stepwise Return-to-Play Protocol

When a player takes a hit to the head, it’s more than just a game pause; it’s a moment where care and caution take center stage. Coaches and trainers are trained to step in quickly, assessing everything from balance to memory. If a concussion is suspected, the athlete steps off the field for further observation. Remember, it’s not just about immediate concerns; ongoing evaluation is crucial to ensure their long-term health. Follow-up appointments with team physicians and specialists may be needed to guarantee a safe return to play.

While details may vary by sport or governing body, most RTP protocols follow a similar graduated, step-by-step process. An athlete must be symptom-free at each stage before advancing to the next:

1. Rest and Recovery
   1. Relative rest/ symptom limited activity where athlete participates in daily activities
   2. No sports, heavy exercise, or screen-heavy activities that worsen symptoms.
   3. Light Aerobic Exercise
      1. Activities like walking, stationary cycling, or light jogging.
      2. No resistance training or contact.
      3. Sport-Specific Exercise
         1. Supervised drills related to the athlete’s sport (e.g., skating for hockey, running drills for soccer).
         2. Still no head contact or risk of impact.
         3. Non-Contact Training Drills
            1. More complex drills and light resistance training.
            2. Trainers and health care providers can assess coordination and skills.
            3. Full-Contact Practice
               1. After medical clearance, the athlete can return to normal training with teammates.
               2. Return to Competition
                  1. Full game play is permitted once the athlete is completely symptom-free and has completed all prior steps without issues.

Each stage typically lasts at least 24 hours. If symptoms return, the athlete must step back to the previous stage and try again later.

Recovery is a team effort. Coaches and parents should watch for warning signs, encourage honest reporting of symptoms, and resist pressure to “rush back.” Athletic trainers and healthcare providers play the most critical role in making safe return-to-play decisions.

Kathryn Dush, P.T., D.P.T. , is a physical therapist at Rehabilitation Services on the campus of MyMichigan Medical Center Midland. She specializes in vestibular and balance dysfunctions, orthopedics, and certified in concussion care. To schedule an appointment, call (989) 832-4220.