Discharge Instructions - Return to Play

Return to play guidelines are typically used for patients who have had a sports injury and want to return to playing the sport.  However the overall principles are applicable for anyone who has had a head injury and wants to return to physical activities.

Depending on which guidelines you look at, there are 5 or 6 stages to returning to play.  Before starting stage 1 you must not have any symptoms.  At any stage, if you experience any symptoms, return to the stage where you didn’t have symptoms (some guidelines also advise seeing your primary care provider to be reassessed).  Stay at each stage for 24-48 hours before trying the next stage.

Baseline

No symptoms, for a minimum of 24 hours

Stage 1

Light aerobic exercise such as walking or biking on a stationary bike.  No jarring activities like hitting a baseball.  Take a few days at stage 2 before moving on to stage 3 (if you have no symptoms).

Stage 2

Sports-specific activities such as skating or throwing, but much reduced from the usual routine.  No jarring exercises.  No high-speed stops.

Stage 3

Drills without any body contact.

Stage 4

Drills with body contact.

Stage 5

A full game with body contact.

If symptoms return and persist despite decreasing your activities, see your primary care provider.

https://www.cdc.gov/headsup/providers/tools.html

https://www.cdc.gov/headsup/providers/return_to_activities.html

Discharge Instructions - Concussion

As discussed in the Emergency Department prior to discharge, you have been diagnosed with a concussion.  Concussions are common after a strong head injury.  For the vast majority of people, concussions last several weeks.  Concussion symptoms vary from person to person.  They usually involve headaches, difficulty concentrating, feeling like you are in a fog, and/or speaking more slowly than usual for you.  If the concussion symptoms last longer than 2 weeks, follow-up with your primary care provider.

While your brain is healing, a second injury (even if it is minor) can have catastrophic consequences.  This is called “Second Impact Syndrome.”  It is extremely rare, but has been reported when an athlete who had a concussion goes back to playing their sport too early, and has a second (even very minor) head injury.  These patients may die from the second injury, so it is extremely important that you avoid having any more head injuries when you have a concussion.

For the first 2 days after the injury, avoid doing any reading, and anything that makes you concentrate hard.  This includes texting, reading on a computer screen, laptop, or smartphone, reading books, magazine text, or newspapers (all of these things make your brain work, when it needs rest).  After that limit the amount of computer/cellphone/laptop use, cutting back still further if your symptoms worsen.

If you had a CT scan and there was no evidence of bleeding on the scan, you do not need to return to the Emergency Department unless you are taking a blood thinner like Warfarin (Coumadin), Apixaban (Eliquis), Dabigatran (Pradaxa), or Rivaroxaban (Xarelto).  These medications are blood thinners and you can have more bleeding if you are taking these medications.

If you had the injury right before bedtime, it might be helpful to have someone wake you up once during the night to make sure that you are okay (there is no scientific evidence that this helps, but 

there is no harm in it either).  If the injury happened in the early evening or earlier, this is not necessary, since you’ve been observed for 4-6 hours before heading to bed.

Return to the Emergency Department for confusion or increasing drowsiness, severe headache and/or vomiting, numbness or weakness in one arm or leg, seizure, or any new or concerning symptoms.

https://www.cdc.gov/headsup/providers/tools.html

https://www.cdc.gov/headsup/providers/return_to_activities.html