Missouri State High School Activities Association advocates a seven step Return to Play protocol that was originally outlines by the 3rd International Congress on Concussion in 2008.
A graduated Return to Play is imperative for a concussed athlete. It allows for the brain to gradually become accustomed to the increased pressure that occurs in the brain with activity. Without the gradual increase in the demand, that athlete may not fully recover for a long period of time.
The first step is Complete Cognitive Rest. This means resting the brain. A 2008 study entitled, Concussion in Sports: Post-concussive Activity Levels, Symptoms, and Neurocognitive Performance, found that athletes engaging in high levels for activity after concussion performed worse on neurocognitive performance. A concussed athlete should stay away from activities that require concentration. Failure to rest the brain may hinder recovery and lengthen the process. After the athlete has been symptom free for 24 hours they can then proceed to step 2.
Step two is a return to school full time.
Step three is light exercise. Under MSHSAA guidelines this step cannot start until the athlete has been asymptomatic and cleared by a physician. This is one of the reasons an athlete is referred to a physician following injury. This step includes light stationary bike and or working. NO Weight Lifting at this time.
Step four is running without equipment.
Step five is non-contact drills with full equipment and weight training may begin.
Step six is full contact or training.
Step seven is play in game. However, they must receive clearance from a physician.
Each step should take 1-2 days with no more than one step in a 24-hour period. If the athlete experiences any recurrence of symptoms the athlete should rest and restart at the next lower step once they are symptomatic.
Andy has been a certified athletic trainer since 2007 when he graduated from Missouri State University. He went on to get his Master’s degree from Emporia State University in Emporia, Kansas. Andy has been working in the secondary school setting since 2008. During that time he has been a part of implementing policies and procedures. Through research and continuing education, he has been able to help put together policies that athletic trainers can use to treat concussions.
Andy’s began playing soccer when he was 5. He played for Firestorm SC in Southwest Missouri. During high school he played goalkeeper for Neosho High School from 1999-2003. Andy began refereeing in 1997. He has progressed to a State 5 referee, participating in the Midwest Regional tournament for 5 years, attending the ODP national Championships in 2010. When the Women’s Professional Soccer league was in St. Louis he was on the list of referees. Along with being a USSF referee Andy is also a MSHSAA referee and a college official.