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An athlete should take at least 1 week to proceed through full rehabilitation, as the graduated return to play (RTP) protocol consists of 6 steps, each of which takes 24 hours to complete. A concussion is defined as impaired neurologic function secondary to an impulsive force transmitted to the head. Signs/symptoms are numerous and include headache, confusion, emotional lability, loss of consciousness, amnesia, irritability and slowed reaction times. The athlete should be removed from the game immediately and once appropriate first aid is administered, the concussive injury should be assessed with sideline tools such as the SCAT3. Following a stepwise progression through the RTP protocol, the patient should be able to return to their sport by 7-10 days. The 2012 Consensus Statement on Concussion in Sport summarized the diagnosis and management of a concussion. The authors detailed a stepwise RTP protocol, initially starting with no activity, progressing through 24 hour periods of light aerobic exercise, sport-specific exercise, non-contact training drills, full contact practice and ultimately returning to play. If a patient develops any post-concussive symptoms while in the program, he/she should complete a 24-hour period of rest and subsequently drop back to the previous asymptomatic level. Halstead et al. reviewed the epidemiology, management, prevention and long-term effects of concussion injuries. Helmets and other protective headgear have shown a protective effect in skiing and snowboarding but the data are less robust for sports such as football, hockey and soccer. Education and recognition remain the most important components of improving care for patients with concussions. Illustration A is a table from the 2012 Consensus Statement on Concussion detailing the RTP protocol and activities for each step. Incorrect Responses: Answer 1: Same day RTP is strictly prohibited in patients with a concussion. Answer 2: The patient must progress through the 6-step RTP protocol and therefore would not be able to RTP within 24 hours. Answers 4 and 5: If the patient becomes symptomatic, he/she must rest and repeat stages and therefore may require more time to RTP; however, progressing asymptomatically through the 6 stages at 24 hours per stage should enable a RTP by ~1 week.
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