Domain 4: Medical Clearance for Full Contact Sport or High-Risk Activity
Recommendations
4.1
Consider patients for medical clearance to return to full-contact activities and sport/game play if clinical criteria have been met.
The following clinical criteria should be considered or met before recommending that a child/adolescent returns to full-contact activities and sport/game play:
- ‘Return-to-Learn’: Return to pre-injury learning activities with no new academic support, including school accommodations or learning adjustments. Child/adolescent has successfully returned to all school activities including writing exams without symptoms above their previous pre-injury level or requiring accommodations related to their concussion/post-concussion symptoms, (i.e., child/adolescent may have pre-existing accommodations or new accommodations related to something other than their concussion).
- Normal neurological and cervical spine examination.
- ‘Complete symptom resolution’: Resolution of symptoms associated with the current concussion at rest with no return of symptoms during or after maximal physical and cognitive exertion (back to the pre-injury state in patients with pre-existing conditions such as baseline headaches or mental health conditions).
- Return-to-Sport: Completion of the Return to Activity/Sport protocol (2023 version) with no symptoms and no clinical findings associated with the current concussion at rest and with maximal physical exertion.
- No longer taking any drugs or substances atypical to their pre-injury functioning that could mask symptom presentation.
For children/adolescents with complex medical histories (e.g., repeated concussion, baseline concussion-like symptoms), see Recommendation 5.1 for information regarding returning to full-contact sports or high-risk activities, or retirement from full-contact sports or high-risk activities.
Definitions for ‘Complete symptom resolution’, ‘Return-to-Learn, and Return to sport have been harmonized with the Amsterdam International Consensus Statement on Concussion in Sport)
Updated Sept 2023
Level of Evidence:
For children/adolescents with complex medical histories (e.g., repeated concussion, baseline concussion-like symptoms), see Recommendation 5.1 for information regarding returning to full-contact sports or high-risk activities, or retirement from full-contact sports or high-risk activities.
4.2
Provide patients with a letter indicating medical clearance to return to all activities when medically cleared.
Level of Evidence:
Link: Canadian Guideline on Concussion in Sport Medical Clearance Letter (Parachute Canada).
4.3
Advise medically cleared patients to seek immediate medical attention if he or she develops new concussion-like symptoms or sustains a new suspected concussion.
Level of Evidence:
Tool 1.2: Concussion Recognition Tool 5. To help identify concussion in children, adolescents, and adults.