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Concussion

Concussion protocol: recognition, removal, return-to-learn and return-to-play

A concussion is a brain injury, not a bruise you shake off. Managed well, most high school athletes recover fully. Rushed, the risk is real and it lasts. What follows is the whole path, sideline to classroom to field, that brings an athlete back safely.

Michael Gordon, ATC, CSCS · Head Athletic Trainer, 20+ years managing concussions · Founder of Strata

The most important rule in this whole guide is four words long: when in doubt, sit them out. You do not need certainty, and you do not need a loss of consciousness to act on it. Suspect a head injury, and the athlete comes out. They do not return the same day. Every state's return-to-play law is built on that one principle.

1. Recognize it

A concussion shows up in two ways, and you watch for both:

Symptoms can be delayed by hours. A "clean" sideline check does not rule out a concussion. That is exactly why documentation and follow-up matter.

2. Remove and evaluate

No same-day return to play. Ever. Take the athlete out yourself. Do not leave that call to the athlete or the coach, because both of them want back in the game. A quiet, one-on-one evaluation with a sideline tool like the SCAT6 helps you document what you are seeing, but the removal comes first, before any test.

Refer to a physician for the diagnosis. Send the family home knowing what to watch for, and be clear about the red flags: worsening headache, repeated vomiting, increasing confusion, a seizure, or unequal pupils. Any one of those means the emergency room, right now.

3. Return to LEARN comes before return to PLAY

This is the step most programs skip. The brain has to handle a classroom before it has any business handling a sport. The mental work of a school day, the screens, the tests, the noise of a crowded hallway, all of it can bring symptoms back. Work with the school on temporary accommodations first: shorter days, more breaks, extended deadlines, less screen time. Let school feel normal again before anything else. An athlete who cannot get through a school day is not ready to progress toward contact.

4. The 6-step graduated return to play

Once the athlete is symptom-free at rest and back to a full school day, they begin the stepwise protocol. Each step is at least 24 hours, and they have to stay symptom-free to advance. If symptoms return at any step, stop for the day, rest, and drop back to the previous step the next day.

  1. Symptom-limited activityEveryday activities that do not provoke symptoms.
  2. Light aerobic exerciseWalking or a stationary bike at an easy effort. No resistance training yet.
  3. Sport-specific exerciseRunning or skating drills. Still nothing that risks a hit to the head.
  4. Non-contact training drillsHarder drills, and light resistance training can be added.
  5. Full-contact practiceOnly after medical clearance. Back to normal training.
  6. Return to playNormal game participation.

Medical clearance is required before full-contact practice, and again before competition. The Athletic Trainer runs the daily progression. The physician clears the contact steps. Both signatures matter, and one does not stand in for the other.

Why the record matters

Concussion management is where good records protect the athlete and the program both. Every symptom check, every step, every clearance should be timestamped and tied together, so nobody advances a day early, and so the trail is clear if a decision is ever questioned. A protocol scribbled across sticky notes and a group text: that is how kids get returned too soon.

Run the protocol, don't wing it

Strata holds the whole concussion episode in one place: daily symptom logs, the SCAT6, the graduated return-to-play steps, and clearance that stays locked until a physician signs off, and a co-signing Athletic Trainer too where that is required. Return-to-play is gated, not guessed.

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Frequently asked

Does an athlete have to lose consciousness to have a concussion?

No. A loss of consciousness happens in only a minority of concussions. Most show up through symptoms and observed signs alone. Suspect it and remove the athlete. Do not wait for a "knockout."

Can an athlete return the same day if they feel fine?

No. Once a concussion is suspected, same-day return to play is off the table. Symptoms are frequently delayed, and the same day is exactly when a second hit, before the brain has had any chance to heal, does the most damage.

What is return-to-learn?

It is a step-by-step return to schoolwork, with temporary accommodations, that comes before return-to-play. The athlete needs to handle a full school day before progressing toward contact.

How long does each return-to-play step take?

At least 24 hours, and only if the athlete stays symptom-free. If symptoms return, they drop back a step. There is no fixed number of days. The symptoms set the pace.

Sources & further reading