Sport after head injury
Disclaimer
These guidelines have been produced to guide clinical decision making for the medical, nursing and allied health staff of Perth Children’s Hospital. They are not strict protocols, and they do not replace the judgement of a senior clinician. Clinical common-sense should be applied at all times. These clinical guidelines should never be relied on as a substitute for proper assessment with respect to the particular circumstances of each case and the needs of each patient. Clinicians should also consider the local skill level available and their local area policies before following any guideline.
Read the full CAHS clinical disclaimer
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Aim
To guide Emergency Department (ED) staff to appropriately advise patients regarding sporting activity after head injury.
Background
- Current evidence supports a gradual return to sport and school following a head injury, with a step wise return to play
- Children who return to sport or school too early are at risk of sustaining complications from their head injury
- The child should have a period of physical and mental rest ('brain rest'). This includes avoiding sporting activities but also activities that require mental concentration including computer use, tablets, television, texting and gaming consoles
- Once the child has been symptom free for 48 hours and feels back to normal, they can commence a gradual return to sporting or school activities as below.
Table 1: Staged return to sport1
Stage 1: No activity (for first 48 hours after injury)
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Complete physical and mental rest
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Recovery
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Stage 2: Light aerobic exercise
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Walking, swimming, stationary cycling
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Gentle increase in heart rate |
Stage 3: Sport-specific exercise
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Running drills at football codes, cricket, basketball, netball, hockey
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Adds movement
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Stages 4: Non-contact training drills
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Passing drills at football codes, cricket, basketball, netball, hockey
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Adds co-ordination and exercise |
Stage 5: Full contact practice
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Participate in normal training activities
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Restores confidence and allows coaching staff to assess progress
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Stage 6: Return to play
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Normal game play
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- Each stage should last 24-48 hours
- If the child remains symptom free, they can move on to the next stage
- If the child develops any symptoms (headache, dizziness, nausea, or tiredness), they should move back a stage and try to progress again after a further 24-48 hour rest period
- If the child has persistent headaches, dizziness, nausea or vomiting, they should be reassessed by their general practitioner or at the Emergency Department.
Table 2: Staged return to school2
Stage 1: No activity
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Complete mental rest
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Recovery
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Stage 2: Minor cognitive activity at home
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Short periods (5-15 minutes) of mental activity (homework)
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Gradual, closely monitored increase in sub symptom threshold activities |
Stage 3: Moderate cognitive activity at home
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Longer periods (20-30mins) of mental activity (homework)
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Increase cognitive stamina, self-paced activity
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Stages 4: Partial school entry
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Part day of school attendance, plus 1-2 hours of homework
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Re-entry into school with accommodation to maintain cognitive load below symptom threshold |
Stage 5: Gradual reintegration to school
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Gradual increase to full day of school attendance
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Increase cognitive stamina
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| Stage 6: Full mental workload resumed |
Catch up on missed work, testing and assessments |
Full return to school |
- Stages 1-3 should last minimum 24 hours
- Stages 4-6 should last 1-2 weeks minimum
- If symptoms recur, the child should go back one step
Information for Parents
Children with significant head injury should be directed to the Concussion in Sport Australia (external website), Sport AUS, Australian Institute of Sport, website to their return to Sport protocol for children which has a more prolonged period before return to sport.3
Other useful concussion information for parents can be found at North Metropolitan Health Services website.
References
- Davis GA, Ellenbogen RG, Bailes J, Cantu RC, Johnston KM, Manley GT, Nagahiro S, Sills A, Tator CH, McCrory P. The Berlin International Consensus Meeting on Concussion in Sport. Neurosurgery. 2018 Feb 1;82(2):232-236. doi: 10.1093/neuros/nyx344. PMID: 29106653. Available from: The Berlin International Consensus Meeting on Concussion in Sport - PubMed (nih.gov)
- Grady MF, Master CL. Return to School and Learning After Concussion: Tips for Pediatricians. Pediatr Ann. 2017 Mar 1;46(3):e93-e98. doi: 10.3928/19382359-20170220-04. PMID: 28287682 Available from: Return to School and Learning After Concussion: Tips for Pediatricians - PubMed (nih.gov)
- Concussion in Sport Australia, Sport AUS, Australian Institute of Sport website. Cited 22 December 2021 Available from: Concussion in Sport Australia | Concussion in Sport Australia
- Return to Sport Protocol for children 18 years of age and under. Concussion in Sport Protocol for children 18years and under. Cited 22 December 2021. Available from: Return_to_Sport_Protocol_-_children_18_years_of_age_and_under.pdf
- Australian and New Zealand Guideline for Mild to Moderate Head Injuries in Children – PREDICT. 2021. Australian and New Zealand Guideline for Mild to Moderate Head Injuries in Children
- PREDICT Algorithm 2021 Cited: 15 February 2022. Available from: PREDICTALGORITHM_v1_1_29.01.21 (2).pdf
| Endorsed by: |
Nurse Co-director, Surgical Services |
Date: |
Apr 2022 |
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