NCAA Guidelines for Concussion Diagnosis and Management (LINK)

[ChattaVol06]

This is interesting and makes sense. Basically, there are 4 steps Hurd would have to clear BEFORE even being able to practice full contact, and he obviously cannot play in a game until he has made it through a full contact practice without showing returning symptoms or effects of the concussion. This is somewhat lengthy but explains the process for everyone.

COMPLETE NCAA CONCUSSION GUIDELINES: http://www.ncaa.org/sport-science-institute/concussion-guidelines

Return-to-Play: Once a student-athlete has returned to his/her baseline, the return-to-play decision is based on a protocol of a stepwise increase in physical activity that includes both an incremental increase in physical demands and contact risk supervised by a physician or physician-designee. Most return-to-play protocols are similar to those in the Consensus Statement on Concussion in Sport guidelines, which outline a progressive increase in physical activity if the individual is at baseline before starting the protocol and remains at baseline throughout each step of the protocol. It is noteworthy that all return-to-play guidelines are consensus-based and have not been validated by evidence-based studies. McCrea and colleagues have reported that a symptom-free waiting period is not predictive of either clinical recovery or risk of a repeat concussion. Further, student-athletes have variable understanding of the importance of reporting possible concussion symptoms. In summary, it should be recognized that current return-to-play guidelines are based on expert consensus.

There is emerging evidence that focused exercise or recovery techniques may be utilized before full recovery has occurred, but more study is needed. Given the paucity of scientific evidence regarding return-to-play and expert consensus documents that have been published, adherence to consensus guidelines is recommended. However, it is important to stress an individualized approach for return-to-play. Some student-athletes may have minimal concussive symptomatology with minimal symptom duration and no modifiers (conditions that may prolong recovery such as prior concussion, migraine, ADHD, depression/anxiety). In scenarios of this nature, and with experienced clinicians in a highly select setting, the return-to-play protocol may be modified. In contrast, if a student-athlete has a concussion history, increased symptom burden or duration, or has symptoms for three to four weeks with other concussion modifiers, then the return-to-play progression should proceed more cautiously and each stage may take more than a day.

Once a concussed student-athlete has returned to baseline level of symptoms, cognitive function and balance, then the return-to-play progression can be initiated, as follows in this general outline:

1. Light aerobic exercise such as walking, swimming or riding a stationary bike. No resistance training. If asymptomatic with light aerobic exercise, then;
2. Mode, duration and intensity-dependent exercise based upon sport. If asymptomatic with such exertion, then;
3. Sport-specific activity with no head impact. If asymptomatic with sport-specific activity, then;
4. Non-contact sport drills and resumption of progressive resistance training. If asymptomatic with non-contact drills and resistance training, then;
5. Full-contact practice. If asymptomatic with full-contact practice, then;
6. Return-to-play. Medical clearance will be determined by the team physician/physician designee, or athletic trainer in consultation with a team physician.

At any point, if the student-athlete becomes symptomatic (i.e., more symptomatic than baseline), or scores on clinical/cognitive measures decline, the team physician should be notified and the student-athlete should be returned to the previous level of activity. Final determination of return-to-play ultimately resides with the team physician/physician designee.