At VAST, we provide concussion assessments and return-to-play evaluations for athletes. This protocol is based on the Concussion Management Awareness Act.
Enacted by the New York State legislature on July 1, 2012, this act outlines rules and regulations related to students who sustain a concussion, also known as a mild traumatic brain injury (MTBI), at any school-sponsored related event or activity.
We formed our post-concussion return-to-play protocol based on the long-term risks and consequences of repeated head injuries and the guidelines established by the State. Clearance by the student’s family physician is one part of several measures we use for a student’s readiness to return.
These protocols were developed in conjunction with school athletic trainers, school nurses, school physicians, and the New York State Public High School Athletic Association (NYSPHSAA) return-to-play protocol. They are based upon the newest international recommendations for management of head injuries and represent “best practice” by the NYSPHSAA and locally by Section VIII Athletics.
East Northport Physical Therapy has initiated ImPACT testing for an athlete, which establishes a baseline to aid in managing suspected head injuries. If an athlete receives a head injury, they will be required to take a post-injury test. Both the baseline test and the post-injury test data can be given to either a family doctor and/or the school’s chief medical officer to help evaluate the injury.
Concussion Management and Return-to-Play Protocol
If a student receives any type of head injury during an athletic practice or contest, they will not be allowed to resume the activity that day. Accordingly, when a student sustains a head injury diagnosed as a concussion, they must be medically cleared by a private physician and remain completely symptom-free for at least 24 hours before return to play is allowed.
Afterwards, there is a mandatory six-day graduated return-to-play schedule that must be followed. If any post-concussion symptoms return, the student should will drop back to the previous level of activity, then re-attempt the new activity after another 24 hours have passed. A more gradual progression may be considered based on individual circumstances and a private medical provider’s or other specialist’s orders and recommendations.
No day may be skipped to speed up the process of full return-to-play. No exceptions will be made to this re-entry process for any reason due to the risk for re-injury.
This protocol applies to mild concussions that are the first for an athlete. More serious concussions involving loss of consciousness and subsequent concussions carry more risk and require a longer process. In these cases, the protocol will be individualized and determined by the athletic trainer, private physician, and school physician working together.
The school physician has the final authority to clear students to participate in or return to athletics and physical education classes.
Adhering to this protocol helps ensure the health and safety of the student-athlete and their safe return to play and competition. Parents, coaches, trainers, and doctors should all work together to help the student-athlete understand the seriousness of a concussion and the importance of following a gradual return-to-play protocol following a head injury.
Post-Concussion Return-to-Play Protocol
These six steps are used to safely return an athlete to play. Day 1 begins after a 24-hour symptom-free period and private medical release.
- Phase 1: Low impact, non-strenuous, light aerobic activity such as walking or riding a stationary bike. If tolerated without return of symptoms over a 24 hour period proceed to phase 2.
- Phase 2: Higher impact, higher exertion, and moderate aerobic activity such as running or jumping rope. No resistance training. If tolerated without return of symptoms over a 24 hour period proceed to phase 3.
- Phase 3: Sport-specific non-contact activity. Low resistance weight training with a spotter. If tolerated without return of symptoms over a 24 hour period proceed to phase 4.
- Phase 4: Sport-specific activity, non-contact drills. Higher resistance weight training with a spotter. If tolerated without return of symptoms over a 24 hour period proceed to phase 5.
- Phase 5: Full contact training drills and intense aerobic activity. If tolerated without return of symptoms over a 24 hour period proceed to phase 6.
- Phase 6: Return to full activities without restrictions with approval of the school physician.