Graded Return To Play Following Concussion… What Is It Really For?

This article is for information purposes only. Book into see a professional to assess your individual case.

There seems to be some confusion in the rugby and football community regarding the need to follow the graded return to play (GRTP) after a suspected concussion. Therefore, the aim of this short blog is to clearly explain why following the protocol is key for returning to your favourite sport, and how this can be achieved by following each stage.

Why do I need to complete each stage of graded return to play following a concussion?

“I feel fine and want to go back to playing” … This is something you might be saying to yourself following a suspected concussion. It’s natural for us to get frustrated when we’re not able to do something we really want to, this is our inner child mindset coming out. However, when it comes to looking after our brains, we need to take more of an adult approach. Indeed, the majority of concussion symptoms resolve within 7-10 days, however, there is good evidence showing that during the recovery period, our brains are more vulnerable to secondary injury, which unfortunately can be much more serious!

 

How does progressing through each stage of graded return to play following concussion look like?

At the start of the rugby season, all players should have completed a mandatory SCAT 5 screening assessment. This acts as a baseline tool to compare against if by any means a player does sustain a concussion. The GRTP is a 6 stage protocol, where each stage is progressively more taxing on the brain. This means that at the end of each stage, a previously concussed player will be required to complete a SCAT test, to compare to his or her baseline scores. If any symptoms occur while progressing through the GRTP programme, the player should rest a minimum of 24 hours until symptom-free and then may return to the previous stage.

 

In total, the earliest return to play is 19 days, however, this can increase if players show a reproduction of symptoms during any stage of the programme.

 

Stage 1 – Initial rest following 

The aim of this stage is to allow your brain and body to recover following a concussion. This means no driving, exercising, studying, and even limiting screen time as much as possible for 24-48 hours.

 

Stage 2A – Relative rest

Here the player can return to their daily activities, such as work, studying, watching TV etc. Including the 1st stage, this part of the protocol will last up to 14 days, therefore it is important that players take it easy during this time, to allow the brain to recover fully, and maximise their chances of getting better. In order to progress to the next stage, the athlete has to show no symptoms during their SCAT assessment at the end of the 14-day period.

 

Stage 2B – Light aerobic exercise

Here the objective is to increase the heart rate and see how the brain will respond to that task. To do so, it is suggested to either jog, swim, or go on a stationary bike for around 10-15 mins. Heart rate should not exceed 70%, and as like with any stage, symptoms will be monitored within 24 hours of completing the activity, with a simple SCAT test.

 

Stage 3 – Sport-specific exercise

We’re halfway there! Here the objective is to add some movement, so players can perform some running drills. No impact during this stage, and the activity should last less than 45 mins, with no more than 80% of the maximum heart rate. Within 24 hours of completion of the activity, a SCAT test should be performed to monitor symptoms.

 

Stage 4 – Non-contact training

The aim of this stage is to work on coordination and increase the cognitive load put upon the brain. This is where players can start working on passing drills, as well as partaking in resistance training, with heart rate reaching no more than 90%. Activity should be performed in under 60 minutes, and as always, symptoms should be monitored within 24 hours of completion.

 

Stage 5 – Full contact practice

Here the players are allowed to partake in their usual training routines, to see how the brain responds to strenuous activity with a lot of contact. SCAT test will be required within 24 hours after training.

 

Stage 6 – Return to play

It’s that time you’ve been waiting for, you can return to playing your favourite sport! This means partaking in normal gameplay, where you will be required to do your last SCAT test within 24 hours of finishing the game. However, there is still a chance of getting symptoms during this stage, so if that is the case, be sensible and rest for at least 24 hours before returning to the previous stage. If no symptoms are present, then you did it, you successfully managed to safely return to play following a serious injury! 

 

You can check out the full HEADCASE guidelines here

I hope this clears things up, and that you now understand the correct pathway to take after sustaining a concussion.

Need help getting back to the sport you love? Book a free phone consultation here…

Stay active, but please stay safe!

By Dom Dasiewicz – Pitchside support for Barnstaple Town FC (Edited By NC)

This article is for information purposes only. Book into see a professional to assess your individual case.

There seems to be some confusion in the rugby and football community regarding the need to follow the graded return to play (GRTP) after a suspected concussion. Therefore, the aim of this short blog is to clearly explain why following the protocol is key for returning to your favourite sport, and how this can be achieved by following each stage. 

Why do I need to complete each stage of graded return to play following a concussion? 

“I feel fine and want to go back to playing” … This is something you might be saying to yourself following a suspected concussion. It’s natural for us to get frustrated when we’re not able to do something we really want to, this is our inner child mindset coming out. However, when it comes to looking after our brains, we need to take more of an adult approach. Indeed, the majority of concussion symptoms resolve within 7-10 days, however, there is good evidence showing that during the recovery period, our brains are more vulnerable to secondary injury, which unfortunately can be much more serious! 

 

How does progressing through each stage of graded return to play following concussion look like?

At the start of the rugby season, all players should have completed a mandatory SCAT 5 screening assessment. This acts as a baseline tool to compare against if by any means a player does sustain a concussion. The GRTP is a 6 stage protocol, where each stage is progressively more taxing on the brain. This means that at the end of each stage, a previously concussed player will be required to complete a SCAT test, to compare to his or her baseline scores. If any symptoms occur while progressing through the GRTP programme, the player should rest a minimum of 24 hours until symptom-free and then may return to the previous stage.

 

In total, the earliest return to play is 19 days, however, this can increase if players show a reproduction of symptoms during any stage of the programme.

 

Stage 1 – Initial rest following 

The aim of this stage is to allow your brain and body to recover following a concussion. This means no driving, exercising, studying, and even limiting screen time as much as possible for 24-48 hours.

 

Stage 2A – Relative rest

Here the player can return to their daily activities, such as work, studying, watching TV etc. Including the 1st stage, this part of the protocol will last up to 14 days, therefore it is important that players take it easy during this time, to allow the brain to recover fully, and maximise their chances of getting better. In order to progress to the next stage, the athlete has to show no symptoms during their SCAT assessment at the end of the 14-day period.

 

Stage 2B – Light aerobic exercise 

Here the objective is to increase the heart rate and see how the brain will respond to that task. To do so, it is suggested to either jog, swim, or go on a stationary bike for around 10-15 mins. Heart rate should not exceed 70%, and as like with any stage, symptoms will be monitored within 24 hours of completing the activity, with a simple SCAT test. 

 

Stage 3 – Sport-specific exercise 

We’re halfway there! Here the objective is to add some movement, so players can perform some running drills. No impact during this stage, and the activity should last less than 45 mins, with no more than 80% of the maximum heart rate. Within 24 hours of completion of the activity, a SCAT test should be performed to monitor symptoms.

 

Stage 4 – Non-contact training 

The aim of this stage is to work on coordination and increase the cognitive load put upon the brain. This is where players can start working on passing drills, as well as partaking in resistance training, with heart rate reaching no more than 90%. Activity should be performed in under 60 minutes, and as always, symptoms should be monitored within 24 hours of completion. 

 

Stage 5 – Full contact practice 

Here the players are allowed to partake in their usual training routines, to see how the brain responds to strenuous activity with a lot of contact. SCAT test will be required within 24 hours after training.

 

Stage 6 – Return to play

It’s that time you’ve been waiting for, you can return to playing your favourite sport! This means partaking in normal gameplay, where you will be required to do your last SCAT test within 24 hours of finishing the game. However, there is still a chance of getting symptoms during this stage, so if that is the case, be sensible and rest for at least 24 hours before returning to the previous stage. If no symptoms are present, then you did it, you successfully managed to safely return to play following a serious injury!  

 

You can check out the full HEADCASE guidelines here

I hope this clears things up, and that you now understand the correct pathway to take after sustaining a concussion. 

Need help getting back to the sport you love? Book a free phone consultation here…

Stay active, but please stay safe!

By Dom Dasiewicz – Pitchside support for Barnstaple Town FC (Edited By NC)