Guidelines: When to Play, When to Quit
- Created on Saturday, 01 October 2011 20:46
- Last Updated on 17.05.2012
- Published Date

Dr. Robert Cantu, whose name is synonymous with "pioneer" in the concussion field, offers guidelines for return-to-play decision makers; when an athlete should terminate their season, and under what conditions it is safe to return to play after an injury. Chief of Neurosurgery at Emerson Hospital in Concord, Massachusetts, and co-director of the Center for the Study of Traumatic Encephalopathy, Dr. Cantu recently stated that children under the age of 14 should not play collision sports until changes are made to help keep their brains safe.
Cerebral concussion occurs frequently in contact sports; more than 250,000 concussion occur annually in football alone. Definitions and classifications of severity of concussion vary, which makes evaluation of data extremely difficult. By combining elements of various definitions, Dr. Cantu has developed a practical guide for determining safe return to play following concussion.
Guidelines for Return to Play After Concussion

*No headache, dizziness, or impaired orientation, concentration, or memory during rest or exertion
Note: A number of "modifying" factors may influence concussion management considerations beyond simple RTP advice. Some of these include number of, duration, and severity of symptoms, number of previous concussions, as well as history of migraines or depression. See Zurich guidelines Table 2.
Gradual return-to-play
The Zurich guidelines, as they are commonly called, were developed by a group of international experts who convened in Switzerland for the purpose of providing a document full of practical information on the subject of concussions. These guidelines include a gradual return-to-play protocol which is a step-wise process that allows the athlete to increase their heart rate and activity level after their physical symptoms have resolved, before returning to full activity. If symptoms reappear while following this protocol, it may be indicative of incomplete healing.
PHASE 1: no physical or cognitive activity
(complete rest) until asymptomatic.
PHASE 2: light aerobic exercise
walking, swimming, stationary cycling with intensity < 70% max. predicted heart rate. No resistance training.
PHASE 3: sport-specific training
skating drills in hockey, running drills in soccer. No head impact activity.
PHASE 4: non-contact drills
more complex training drills (passing drills in football or ice hockey). May start progressive resistance training.
PHASE 5: full-contact practice
following medical clearance, participate in normal training activities.
PHASE 6: return-to-play
normal game play
Note: If symptoms return during any part of the protocol, wait 24 hours and begin again at that same phase.
Source: Consensus statement on concussion in sport -- The 3rd International Conference on concussion in sport, held in Zurich, November 2008 Br J Sports Med 2009;43:i76-i84 doi:10.1136/bjsm.2009.058248
Questions/comments? Contact Jean Rickerson at This email address is being protected from spambots. You need JavaScript enabled to view it.
Health
EAST LANSING, Mich. — New research out of Michigan State University reveals female athletes and younger athletes take longer to recover from concussions, findings that call for physicians and ...
read more...-
Head injury accounts for most bicycle-related deaths
Most bicycle share riders skipping helmets
BOSTON – A national rise in public ...
-
Changing brains for the better
MADISON – Practices like physical exercise, certain forms of psychological counseling and medit...
-
Physical activity boosts learning
INDIANAPOLIS – School administrators looking to restructure the academic schedule should consid...




Neuroscience
New Findings Provide Important Data for Refining Diagnosis
Postmortem analysis of the brains of ten professional athletes with chronic traumatic encephalopathy (CTE) provides new insights into the ...
read more...-
Structural changes in brain after injury
RICHMOND, Va. (May 10, 2012) – Even mild head injuries can cause significant abnormalities in b...
-
PET scans yield surprises
Brain scans of a concussed football player and a comatose accident victim yielded similarities th...
-
Heading in soccer; the investigation continues
Could heading the ball in soccer lead to degenerative brain disease, like that seen in...
Resources
- School professionals play an important role in the health of all students. Recognizing the signs and symptoms of concussion is important, as is managing their return to school post-injury.
- Some ...
- CDC's Concussion Training for Clinicians
-
Concussion Education Video Programs - ...
Parents, athletes, coaches and medical professionals have access to concussion education created...
-
New concussion guidelines for team ...
INDIANAPOLIS – Team physicians who assess and treat athletes suspected of concussion have new ...
ASK THE EXPERT
Former NFL QB Kurt Warner
Two-time NFL MVP
Q: Is football safe enough for youth?
Find a Sports Medicine Physician Near You
quick links
Latest News
The Pro View
Leigh Steinberg, Sports Agent
CEO Steinberg Sports and Entertainment
Clients included Troy Aikman, Warren Moon and more
Concussions Occur...
...in Any Sport
REMOVE athlete from play
REFER to medical provider
REST no sports, no texting/TV
RETURN only with doctor's OK
Source: Children's Hospital Boston, Sports Concussion Clinic




















