Concussion Information

MHSAA Concussion Rules and Return to Play Protocol

The MHSAA requires that any student athlete who exhibits signs or reports symptoms of a concussion resulting from participation in a sport be removed from participation until they are evaluated and cleared by a qualified provider (i.e. MD, DO, NP, PA) This clearance must be written and unconditional and must be completed on the MHSAA Return to Activity form. This form also requires parent and student consent. This clearance must be obtained before the student athlete may return to full and/or contact practice or contests.

Return to Play is a four day process. Days 1 and 2 are 30 minute High Intensity Interval type workouts under the supervision of the athletic trainer. Day 3 is a non contact practice, or for non contact sports, half of a practice. Day 4 is full contact practice. Contests or games do not count as day 4. The athletic trainer can do Days 1-3 without the clearance from the doctor or qualified health care provider, but cannot move to Day 4 until that clearance is obtained. If there is a delay getting in to see a provider, the athlete will continue in non contact practice and not participating in games until that clearance is secured.

Defining Concussions

Concussions are a form of mild brain trauma that result in temporary disruption of normal neurological functioning. Concussions are caused by a bump, blow, or jolt to the head or by a hit to the body that causes the head and brain to move or stop abruptly. This sudden movement causes the brain to shift and contact the inside of the skull causing physiological changes to the affected neurons.

Symptoms of a Concussion

Important Notes:

• Concussions do not require a loss of consciousness. In fact approximately 90% of concussions are not accompanied with a loss of consciousness
• The appearance of concussion signs or symptoms may be delayed several hours or even days following the original incident. It is important to continue to monitor someone who has suffered a head injury for several days before completely ruling out a concussion
• If a student-athlete complains of any of the above symptoms after sustaining a blow to the head or body as described above, it is important to immediately notify the school’s athletic trainer to allow them to evaluate the injury and determine if it is indeed a concussion. Disclosure of these symptoms and any resulting head injury to the school’s athletic trainer is required by school policy.

Treating Concussions

When signs or symptoms of a concussion arise during athletic participation, the first step is to immediately remove the student-athlete from participation. Research has shown that athletes who are not removed immediately after a concussive injury are approximately 9 times more likely to experience a prolonged recovery. Additionally, athletes who were not removed needed nearly twice as long to recover and experienced more sever post-injury symptoms than those who were removed immediately.

The second step is to report the injury to the school’s athletic trainer. The school’s athletic trainer can then assess the student athlete and determine whether a concussion has been sustained and the best course of action. If the injury occurs outside of a school sport or during a time when the athletic trainer is unavailable, you can contact your primary care physician or local concussion specialist for further evaluation, or seek care at your local hospital’s Emergency Department if any of the following red-flag symptoms present.

Head Injury Red Flags

• Loss or decreased level of consciousness during or after injury
• Severely worsening headache
• Seizures
• Unequal pupil size
• Slurred or incomprehensible speech
• Repetitive vomiting
• Increased confusion
• Unusual behavioral changes or increased irritability/combativeness
• Weakness, numbness, tingling, or paralysis in arm(s) or leg(s)

These red flag symptoms may be a sign of a more significant brain trauma, such as intercranial hemorrhage, which can be life threatening. However, in the absence of these red flag symptoms, it is not necessary to seek immediate emergency intervention or advanced imaging for a sports-related concussion. Conventional CT and MRI scans are most often found to be normal in sports-related concussion.

If the student-athlete is evaluated by a qualified health care provider (i.e. MD, DO, NP, PA, or athletic trainer per the State of Michigan) and has been diagnosed with a concussion or is being monitored for a concussion, the following are best practice recommendations:

Recovery and Return to Play

Because the human brain is so unique from individual to individual, there is no ‘one size fits all’ approach for concussion management or return to play timeline. Instead each concussion management plan should be individualize based on physical and neurocognitive findings, preexisting health history, and other contributing factors.

Post Concussion Syndrome

The vast majority of concussions are found to resolve within 10-14 days after the onset of symptoms, however some cases can persist for several weeks or months. Once concussion symptoms extend past the 10-14 day period, they are no longer considered to be a part of the initial injury and are instead categorized as post concussion related.

Research is still developing in this area with experts divided on whether these unresolved symptoms are a result of structural damage and disrupted neuropathways or rather related to the psychological factors, as the most common symptoms – headache, dizziness, and sleep problems – are similar to those often experienced by people diagnosed with depression, anxiety, or post-traumatic stress disorder (PTSD). Additionally, those with a history of depression, anxiety, or PTSD, as well as factors such as significant life stressors, a poor social support system, and lack of coping skills see higher frequencies of developing post concussion symptom. Developing post concussion symptoms does not, however seem to be related to the severity of the initial injury.