Concussion Program

For Coaches

The Children’s National SCORE program partners with coaches across the Washington, D.C., Maryland and Virginia region – and across the country. We strive to support them in recognizing and responding to concussions as well as fostering brain health more broadly in their players. If you are interested in learning about brain health education or further consultation please contact us.

All concussions are serious and most occur without loss of consciousness. Recognizing and properly responding to concussions when they first occur can help prevent further injury. Remember the mantra “when in doubt, sit them out,” when caring for an athlete with a suspected concussion.

Athletic organizations, trainers and coaches need to recognize and respond to a suspected concussion, and then facilitate management if one of their athletes is injured. It is important that all adults in a young athlete’s life support full recovery.

Concussion Basics

What is the definition of full recovery from a concussion?

What are the risks of incomplete recovery?

How should an athlete return to play after a concussion?

Only when an athlete’s symptoms are gone, and in consultation with their healthcare professional, should he or she slowly and gradually return to sports practice, following a Progressive Activity Program, as described below. When available, be sure to work closely with the team’s certified athletic trainer.

Progressive Activity Program

The timing and duration of each of these steps depends on the athlete’s recovery, so this activity program should be tailored as needed.

Step 1: Begin with light aerobic exercise only to increase an athlete’s heart rate. For example, this means about five to 10 minutes on an exercise bike, walking or light jogging. No weight lifting at this point.
Step 2: Continue with activities to increase an athlete’s heart rate with body or head movement. This includes moderate jogging, brief running, moderate-intensity stationary biking or moderate-intensity weight lifting (reduced time and/or reduced weight from the athlete’s typical routine).
Step 3: Add heavy non-contact physical activity, such as sprinting/running, high-intensity stationary biking, regular weight lifting routine or non-contact sport-specific drills (in three planes of movement), for a total duration of a typical practice.
Step 4: Athlete may return to practice and full contact in controlled practice.
Step 5: Athlete may return to competition.

Frequently Asked Questions for Coaches

As a coach, what is important for me to know about the treatment and management of a concussion?

There are two important things to do after a concussion to help recovery. First, make sure that the athlete does not participate in any higher risk activities where they could take additional blows to the head or body. Second, to help the brain heal as quickly as possible, balancing cognitive (thinking) and physical rest with rest breaks are also very important. Only allow the athlete to return to higher risk activities (practices, scrimmages and competition) after a qualified healthcare professional knowledgeable about concussion evaluates and clears the athlete to do so. As the child is recovering, reinforce that their brain health is the most important thing to focus on and support opportunities that may allow the athlete to safely participate with the team (e.g., non-contact exercise, being manager of the team, keeping score, etc.).

How do I know if an athlete on my team had a concussion?

As the coach, you don't have to diagnose the concussion. Your job is to recognize a possible concussion by observing two things: (1) a blow to the head or body that is concerning and (2) any sign or symptom that tells you something may not be right with the athlete. Use the signs and symptoms information to assist you, download a phone application before the season or go to the CDC for a list of signs and symptoms. If you have a reasonable suspicion that these two indicators are present, follow the motto: When in doubt, sit them out. This means that if you suspect a concussion may have occurred, you should immediately pull the athlete out of practice/play, inform their parents about what happened, and direct the parents to information about concussions, and how to get medically evaluated.

A concussion is defined as a direct or indirect force to the head (could be a direct hit or a whiplash-type injury) that results in neurological impairment. If you see or are told that a child has received a blow, you should ask specific questions about their condition, as guided by a reputable concussion tool.

What is a Gradual Return to Play program?

A gradual return to play (RTP) program used to be the the last step in concussion recovery before returning to sports participation, but newer recommendations have changed. This RTP program used to wait until an athlete is fully without any symptoms, before beginning steps 1 and 2 (light-moderate exercise). With new research related to the benefits of early light to moderate exercise, steps 1 and 2 of the RTP may begin while an athlete continues to have some symptoms. It is important to note that his is really as a method of using exercise as a tool for treatment, and an athlete should never progress to any strenuous or high risk sports activities until the symptoms have fully resolved. The RTP program typically takes place over 5-7 days (or longer, depending on how long symptoms last) with close monitoring for any significant increase of post-concussion symptoms at each stage. The athlete goes through a set of physical activities that gradually increase in intensity and movement. Once the athlete is able to demonstrate a high level of physical activity, with sport-specific movements, and controlled contact (when appropriate), and has received written medical clearance from a healthcare professional, they are then ready to return to full sports participation, including practice and games.

What should I be doing before our season starts to protect my athletes?

First, educate yourself about the injury. The next thing to do in preseason is to emphasize to the athletes and their parents the importance of taking these injuries seriously. Explain that a concussion is an injury to the brain and is very serious. Next, to help with recognition, review the signs and symptoms of concussion, using the CDC Athlete Fact Sheet or similar phone application. Stress to the athletes that they are responsible for not only themselves but also their teammates. Also, emphasize the importance of wearing properly fitted equipment (e.g., helmets, mouthguards) for general protection, yet also that these pieces of equipment do not prevent concussions. Teaching proper technique in the sports is also important. Explain to the team that you will not allow unsafe play.

What should I tell the parents of my athletes who are worried about concussions?

Where can I get more information?

Resources for Athletic Organizations and Coaches

General information

Videos

Helpful apps and websites

Apps

The CDC has developed two concussion-related apps that coaches, parents and schools may find helpful.

Websites