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What is a concussion?

A concussion occurs when there is a direct blow or force to the head that causes a change in mental status.  During a concussion, the brain is demanding more energy than it is receiving.  Therefore, it can lead to symptoms such as disorientation, confusion, memory loss. And/or slowness in thinking.

Who does it affect?

Concussions occur often in sports.  Contact sports such as soccer, football, wrestling, hockey, and basketball have the highest prevalence of concussions.

Signs and Symptoms of Concussions

Athlete May Report:

  • Headache or pressure in head
  • Dizziness
  • Nausea or vomiting
  • Blurred/double vision
  • Sensitivity to light
  • Difficulty concentrating
  • Difficulty remembering/loss of memory
  • Spots before eyes
  • Sensitivity to sound
  • Ringing in the ears
  • Feeling “in a fog”

Coach or Parent May Observe:

  • Loss of consciousness
  • Sleepiness, grogginess
  • Balance problems
  • Slowness in responding
  • Slurred speech
  • Abnormal behavior
  • “Out of it” behavior


The Concussion Return-to-Play Protocol, BRAIN G:

When returning to play following a concussion, the following protocol, or a similar protocol,  will be used to safely progress their return to play.  This should be performed under the direction of a qualified medical provider.  It is recommended that there be approximately 24 hours between each stage.

Rehabilitation Stage Functional Exercise Success Goal
No Activity Complete physical and mental rest. Recovery and symptom free rest.
Low Exertion Stationary cycling keeping intensity. Increase heart rate without being under 70% maximum predicted heart rate symptoms (30 minute max).
Increased Exertion Running while keeping intensity. Can add movement without symptoms. Increase heart rate without being under 70% maximum predicted heart rate symptoms. (30 minute max)
High Exertion Sport-specific exercises. No head-impact activities. Add coordination and cognition without symptoms.
Non-Contact Practice Full practice without contact may start along with progressive resistance training. Increase exercise, cognitive load and coordination without symptoms.
Return to Play Normal game play.

Protocol established from: “Consensus statement on concussion in sport – The 3rd International Conference on concussion in sport, held in Zurich, November 2008.” Journal of Clinical Neuroscience. (2009) 16:755–763

Return to Participation*: An athlete will not return to participation the same day as a concussive event. An athlete is able to return to play when they are symptom-free at rest and at exertion and have returned to a baseline state of any of the tests they were administered. When returning athletes to play, they will follow the stepwise symptom-limited program outlined above.

^Above information is from Athletico Physical Therapy

Recommended Concussion Physicians:

Dr. Mark Halstead, MD | Washington University Physicians | 14532 S. Outer Forty Drive, Chesterfield, MO 63017 | Appointment Number: 314-514-3500

For more information, please visit the MSHSAA Sports Medicine Page OR the Athletico Head Injury and Concussion Page


Concussion Packet

2016 MSHSAA Return-to-Play Form