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.