"Return to Play" refers to a protocol of graduated increase in activity level, until an athlete can fully return to full participation in their sport.
What is a Return to Play Protocol?
The most important part of the RTP is supervision; a player might not be 100% honest about their symptoms, however the people around him or her can help notice if they are not fully recovered. A coach may be able to notice that during non-contact drills a player is not reacting as quickly as usual, or as not responding as sharply to stimulus. A parent may notice that the player is apprehensive or displaying personality changes after stress. An Athletic Therapist can notice if fine motor skills are deficient, or if the player is not able to recover post-exercise as quickly as expected.
If I've been cleared by the doctor, why bother?
Typically speaking, a family physician can assess if there are any current symptoms reported by the patients or observable signs of concussion. If at time of assessment there are none, or none reported, the doctor can and often will 'clear' a player for return to full contact sport without restriction. Sometimes this is accompanied by a suggestion of a return to play protocol, but not always.
It is very difficult to identify a gap in family health care without sounding as though I am criticizing the system, however it is often the case that family doctors are simply not highly experienced in the return to play process following a sports related concussion. It is rare that they will have access to facility or equipment to perform a stress test. Unless the patient had been referred on to a neurologist, sports medicine physician or other type of specialist, it is unlikely that the family doctor will perform or recommend a graduated protocol.
This is why it is so important that there be a broader support network for a patient who is recovering from concussion. This network should include patients and coaches who are educated about concussion, as well as an Athletic Therapist.
What are we looking for in a return to play protocol?
There are many factors that influence a player as they have not yet recovered. Increase of blood pressure can contribute to inter-cranial pressure, which the body under normal circumstances should easily be able to handle. This change can in turn effect the autonomic system and chemical cascades in the brain to decrease the body's ability to self regulate. In addition, changes in body position can effect the complex structures in the vestibular system, and slightly delay the processing of information from the visual system causing disorientation and dizziness. This can't be predicted without stressing the system.
The ultimate reason for completing a return to play protocol is to avoid second impact syndrome. Recall that second impact occurs if a second concussion is sustained when the brain and body are still recovering from the first. While a concussion is not a life long condition, second impact syndrome often is. In many cases, permanent brain damage is sustained, and death can occur.
Take Home Message
In Guelph and the surrounding area, Alana Gulka Athletic Therapy is available to conduct baseline testing, and education seminars about concussions and how to best handle them. Please contact us for more information.