If your young athlete takes a hard hit to the head during a game, whether in football, baseball soccer or any other sport, the first thing you should do is remove him or her from play until a doctor can check for a concussion.

If it is a concussion, your athlete will have to rest for several days, depending on the severity of the injury.

But like most eager athletes, your son or daughter will be anxious to return to school and eventually get back on the field.

“When your child gets a concussion, the brain moves around inside the skull, which can cause a temporary disruption in normal brain activity,” said Geisinger sports medicine specialist Justin G. Tunis, M.D. “A medical professional should be the one to decide when it’s safe for the athlete to get back on the field, not a coach or a parent.”

The first step in determining whether your athlete is ready to play again is to confirm that all the symptoms of a concussion are gone for at least 24 hours. Symptoms of concussion may include:

  • Headache or head pressure
  • Dizziness or blurred vision
  • Difficulty maintaining balance
  • Feeling fatigued or sluggish
  • Confusion
  • Feeling “off” or “down”
  • Difficulty sleeping

As your athlete recovers, if he experiences any of these symptoms again, it’s recommended he stop the aggravating activity until the symptoms cease once again for 24 hours.

After your child is feeling better and a medical professional clears her for activity, an athletic trainer can work closely with her to ensure she is ready for sports again.

Geisinger Health System’s “Return to Play” protocol helps athletic trainers follow a standard set of steps to ensure that athletes are fit for strenuous exercise and contact sports after they get a concussion.

“The ‘Return to Play’ protocol consists of six stages of progressively more strenuous activity. When a young athlete completes all of the activities without any concussion symptoms returning, he or she is ready to play in competition again,” said Dr. Tunis.

The first stage includes a 15-minute, low-impact biking or other aerobic workout at a light pace. The second stage is a 20-minute bike sprint or inclined treadmill workout. If the athlete completes both stages without experiencing any concussion symptoms, she can move on to the following stages with more strenuous exercise.

During stage three, an athletic trainer may ask the athlete to complete an on-field workout of a short warmup, followed by travelling exercises (drills involving movement), stationary exercises and conditioning exercises like shuttle runs or running up stadium steps. Alternatively, the athlete may complete a weightlifting workout and a multi-directional movement workout.

“As the stages progress, we start to look at athletes’ balance, reaction times, and how they respond to a more taxing workout,” said Dr. Tunis.

Stage four builds on previous stages and includes an exercise stress test that increases exertion, which ensure the body responds well to increased blood pressure with occasional spikes.

If the athlete successfully completes the stress test, he should try a team practice without physical contact.

In stage five, athletes are encouraged to return to a team practice without restrictions. If they complete practice without any concussion symptoms, they can return to competitive play.

It’s important to note that the guidelines can and should be modified for each individual athlete based on fitness levels as well as the severity of the concussion and associated symptoms.

“By creating a complete protocol with several stages and suggested workouts, we’re ensuring that each athlete is treated the same way after a concussion,” said Dr. Tunis.