Return to Learn (or work) Protocol Following Concussion

After sustaining a concussion, it is important that you follow a structured protocol to safely return to your regular activities. The priority should be to resume your cognitive activities (i.e. school and work) prior to returning to sports. A trained healthcare professional can help safely guide you through the following steps:

1. Complete mental rest
2. Short periods of cognitive stimulation at home (ex: reading and restricted television/screen time)

3. Complete school activities at home (ex: some homework, reading, and other cognitive activities outside of the classroom like Sudoku and cross-word puzzles)

4. Return to school on a part-time basis with restrictions as needed (ex: half days with more breaks as needed; focus on core classes like math and science first)

5. Return to school full-time without restrictions

The time needed to move through each step will vary between individuals. In order to successfully complete each step, the recommended task(s) must not provoke symptoms for at least 24 hours. If symptoms occur while trying to complete the designated task(s), you need to return to the previous step until it is well tolerated for 24 hours before trying the next step again.

For example, if you get a headache that persists for the rest of the day after reading for 5 minutes (Step 2) then you are not ready to progress to the next step which requires more concentration such as completing homework (Step 3). You need to return to Step 1 (complete mental rest) for 24 hours and if symptoms subside, you may try Step 2 again.

It is also important to note that according to the Quebec Ministry of Education, students (up to age 17) will need to have a medical note from a physician to confirm their diagnosis and have modifications made to their school schedule.

Return to Play Protocol Following Concussion

Once a full and safe return to learn has been achieved, you may begin the following protocol to resume your physical activities. A trained healthcare professional can also help guide you through the following steps:

1. Complete physical rest until symptom-free.
2. Can begin light aerobic exercises such as walking or stationary biking at slow to medium pace. NO resistance training or weight-lifting. Athlete should be able to tolerate 15-20 minutes without symptoms before progressing to the next level.

3. Can begin sport-specific activities and training without any head impact (ex hockey players can start skating).

4. Can begin non-contact training drills (ex: hockey players can start more advanced skating drills with stick and equipment). Light resistance training can also be resumed. Before progressing to the next step, athletes should get medical clearance from a trained professional (doctor, physiotherapist, osteopath etc… who has experience working with people who have had concussions).

5. Begin training drills with body contact and normal training activities.
6. Full Return to Sport without restriction

As per the return to learn protocol, the time needed to progress through each step may vary. In order to successfully complete each step, the recommended task(s) must not provoke symptoms for at least 24 hours. If symptoms occur while trying to complete the designated task(s), you need to return to the previous step until it is well tolerated for 24 hours before trying the next step again.

For example, if you are ready to start light biking (Step 2) and can only complete 10 minutes and you get a headache that persists for the rest of the day, you need to you to go back to Step 1 (complete mental rest) for 24 hours before trying to bike again if symptoms have subsided.

It is also important to note that according to the Quebec Ministry of Education, students (up to age 17) will need to have a medical clearance from a physician to begin any form of contact sport (Before starting Step 5).

Vanessa Beaumont, Physiotherapist

Kinatex Sport Physio Côte-Vertu

References

• McCrory, P. et al. 2017. Consensus statement on concussion in sport—the 5th international conference on concussion in sport held in Berlin, October 2016. British Journal of Sports Medicine. Vol 0: pp. 1-10.
• Concussion Management Protocol for Education Institutions for Recreational and Sports Activities. Ministère de l’Éducation et de l’Enseignement supérieur (Gouvernement du Québec). Retrieved March 12th, 2018 from:

http://www.education.gouv.qc.ca/fileadmin/site_web/documents/SLS/promotion_securite/16-00460_Protocole_de_gestion_des_commotions_cerebrales_AN_1.pdf

• Fait, P. and Langevin, P. 2017. Formation Kinatex: Le traumatise craniocérébral léger : de la blessure au retour à la fonction, October 27th, 2017 [powerpoint slides].