Q&A About Returning to Play After a Concussion

Matthew Grady, MD, and Christina Master, MD, concussion experts from The Children's Hospital of Philadelphia, explain why it's very important to not delay evaluation and management of a concussion. Early recognition followed by early rest are the best solution for long-term recovery. Delaying the evaluation will mean the symptoms will linger and recovery will take longer. They also talk about the return-to-play protocol which gives the best indication of an athlete's readiness to return to play.


Q&A About Returning to Play After a Concussion

Student athlete 1: I can handle the pain.

Student athlete 2: Know I can play through, you know, whatever I have.

Student athlete 3: My team needs me.

Student athlete 4: I don't want to let anybody down.

Student athlete 5: My coaches, my parents, my school—

Student athlete 6: It will hurt my chances to play in college.

Student athlete 7: Why should I tell you about my symptoms if they're just going to keep me from practicing and competing?

Matthew Grady, MD: So if an athlete has symptoms of a concussion and chooses not to tell a medical provider, then we're putting them in harm's way.

Christina L. Master, MD: You also run the risk of getting an injury on top of your first injury, which could make the recovery from the concussion very prolonged, potentially putting you out not just for a couple of games but for an entire season.

Matthew Grady, MD: And so while I may salute an athlete for their courage in taping up their ankle and going back to play, I think we're talking about your brain here. As a physician, I'm interested in making sure that I preserve your long-term career. I don't want to have you play in one game and risk the potential injury that may change your life.

Student athlete 5: I think everyone is just being over cautious.

Student athlete 3: I only see negatives about not playing the game.

Student athlete 8: Are there any benefits of staying out of the game?

Matthew Grady, MD: So from a long-term when-can-I-play-again perspective, early recognition followed by early rest gives the best long-term recovery solution.

Christina L. Master, MD: The earlier you take care of it, the better off you're going to be. But if you delay pulling yourself out and getting the rest that you need to get your concussion to heal, the more likely you are to have issues that will be longer in terms of symptoms and recovery.

Matthew Grady, MD: After the brain is injured, the body needs fuel to heal the brain cells. If we divert fuel to other activities, such as schoolwork or running around, we take away fuel, potentially, from those healing cells. We know that early in the process there's a big demand for those cells to heal, and so we want to minimize the demands for other things and divert all our resources to those injured cells.

Christina L. Master, MD: There is no gain from pain.

Matthew Grady, MD: The risk you're taking is substantial, and the consequences of having another injury while you're not healed could be devastating to your long-term future.

Lacrosse coach: When is it safe for an athlete to return to practice or competition?

Christina L. Master, MD: So when your athlete has suffered a concussion, what's important to look for in terms of recovery is that they're back to full cognitive workload, so full day school, full day workload, all the homework and the testing, and also caught up with everything so that they're not behind.

Matthew Grady, MD: Once an athlete is in school and asymptomatic, we start them exercising. There is a series of steps they do, from the start of exercise back to full play. These are classically called a return-to-play protocol.

Christina L. Master, MD: That means really in full-out, hard, cardiac aerobic exertion, non-contact skills and drills to get their timing back in terms of their sport-specific skills, and then being able to handle all of that at the normal level.

Matthew Grady, MD: An athlete is clear to play after they can do both physical and cognitive activity without any symptoms.

Topics Covered: Concussion

Related Centers and Programs: Minds Matter Concussion Program