Medical Release For Return To Athletic Participation Following A Concussion Or Other Injury (Page 2 of 2) in pdf

RETURN TO PARTICIPATON PROTOCOL FOLLOWING A CONCUSSION

(GUIDELINES FOR LICENSED HEALTH CARE PROVIDERS)

Return to participation following a concussion is a medical decision made on an individual basis by

licensed health care providers. Medical experts in concussion believe a concussed student should meet

ALL of the following criteria in order to progress to return to participation. However, these criteria are

GUIDELINES ONLY and not required by Iowa Code Section 280.13C when licensed health care providers

determine a student’s return to participation.

Asymptomatic at rest, and with exertion (including mental exertion in school), AND have written

clearance from physician, physician’s assistant, chiropractor, advanced registered nurse practitioner,

nurse, physical therapist or licensed athletic trainer . *Written clearance to return by one of these

licensed health care providers is REQUIRED by Iowa Code Section 280.13C!

Once the criteria above are met, the student should progress back to full activity following the

stepwise process detailed below. A licensed health care provider as defined in Iowa Code Section

280.13C, or their designee, should closely supervise this progression.

Progression to return is individualized and should be determined on a case-by-case basis. Factors

that may affect the rate of progression include: previous history of concussion, duration and type of

symptoms, age of the student, and sport/activity in which the student participates. A student with a history

of concussion, one who has had an extended duration of symptoms, or one who is participating in a

collision or contact sport may progress more slowly as determined by a licensed health care provider as

defined in Iowa Code Section 280.13C, or their designee.

Step 1.

Complete physical and cognitive rest. No exertional activity until asymptomatic. This may

include staying home from school or limiting school hours (and studying) for several days.

Activities requiring concentration and attention may worsen symptoms and delay recovery.

Step 2.

Return to school full-time /normal cognitive daily activities, or normal cognitive

functions.

Step 3.

Low impact, light aerobic exercise. This step should not begin until the student is no longer

having concussion symptoms and is cleared by the treating licensed health care provider. At

this point the student may begin brisk walking, light jogging, swimming or riding an exercise

bike at less than 70% maximum performance heart rate. No weight or resistance training.

Step 4.

Basic exercise, such as running in the gym or on the field. No helmet or other equipment.

Step 5.

Non-contact, sport-specific training drills (dribbling, ball handling, batting, fielding, running

drills, etc.) in full equipment. Weight-training can begin.

Step 6.

Following medical clearance*, full contact practice or training.

Step 7.

Normal competition in a contest.

NOTE: Generally, each step should take a minimum of 24 hours. If post concussion symptoms occur at

ANY step, the student must stop the activity and their licensed health care provider as defined in Iowa

Code Section 280.13C should be contacted. If any post-concussion symptoms occur during this process, the

student should drop back to the previous asymptomatic level and begin the progression again after an additional

24-hour period of rest has taken place.

References: “Suggested Guidelines for Management of Concussion in Sports,” NFHS Sports Medicine Advisory Committee

2009; “Consensus Statement on Concussion in Sport 3

International Conference in Sport Held in Zurich, November 2008,"

Clinical Journal of Sports Medicine, Volume 19, Number 3, May 2009.

Updated 05/22/12

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Medical Release For Return To Athletic Participation Following A Concussion Or Other Injury Page 2

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