Concussions in Youth Sports

By: Megan Smithuysen, LAT, ATC

Chances are that if you have a youth athlete in your household, then you are familiar with the signs and symptoms of a concussion. Thanks to organizations such as the National Football League (NFL), the word “concussion” has become a household term. According to health insurance company Blue Cross Blue Shield, medical claims data shows a 71% increase in reported concussions in American youth since 2010. Organizations like the NFL have very publicly endorsed the importance of not only recognizing and treating a concussion, but endorsing concussion education as well. Several studies show a direct correlation between the media’s concussion coverage and an increase in athlete reporting rate. As familiar as most parents are with the word concussion, many are not familiar with the management aspect that comes after a concussion diagnosis.

In 2011, New York Governor Andrew Cuomo signed a statewide youth-concussion legislation known as the “Concussion Management and Awareness Act.” This law essentially requires all public school districts to adopt and implement rules, regulations, and a protocol for the recognition, treatment, and monitoring of students who are suspected of sustaining a concussion. Private schools are encouraged to create and adopt similar policies.

There are three main components to the “Concussion Management and Awareness Act.” The first component is that schools must obtain a parent/guardian signed permission slip before any student participates in an athletic program. By signing the permission slip the parents/guardians are recognizing the assumed risk of playing a sport. Second, any student suspected of sustaining a concussion must be immediately removed from play. This is where a Certified Athletic Trainer steps in. In accordance with the law, a Certified Athletic Trainer performs what is called a sideline concussion evaluation. This consists of a series of cognitive and physical tests that showcase common signs and symptoms of a concussion. It is the Certified Athletic Trainer’s job to then make the appropriate medical referral and provide the student and their parents/guardians with further care instructions. It should be noted that the law does not designate coaches as able to evaluate a student for a suspected concussion. The coach’s role is to be able to recognize the common signs and symptoms of a concussion and bring the student to an appropriate medical personnel who may then conduct the evaluation.  

Students who have been diagnosed with a concussion require both physical and cognitive rest. Cognitive rest requires that the student avoid participation in activities that require concentration or mental stimulation. Some common examples of these activities include working on computers, watching TV, playing video games, texting, loud music, bright lights, studying, reading, writing, and completing homework. For students whose concussive symptoms are significant, a 504 plan may be appropriate for their plan of care. Section 504 is part of the Rehabilitation Act of 1973 that requires a school district to make appropriate accommodations for individuals with disabilities to ensure their academic success. While a 504 covers a wide range of disabilities and accommodations, for a student recovering from a concussion, these usually consist of extended due dates, extended testing time, and extra help. The student’s doctor and the school district’s Guidance department will dictate the specifics of the 504 if needed.

The third component of the “Concussion Management and Awareness Act” is that any student suspected of a concussion must obtain full medical clearance from a licensed physician before returning to their respective sport. Once the full medical clearance has been given to the school nurse and/or Certified Athletic Trainer and the student remains symptom free for 24 hours, they then begin a monitored graduated return to play. While the law does not mandate a specific graduated return to play, it does outline a recommended progression based on the 2012 Zurich Consensus Statement on Concussion in Sport.  The following is the recommended return to play provided by the New York State Public High School Athletic Association (NYSPHSAA).

Phase 1– Low impact activity such as walking or riding a stationary bike, Approx. 20 mins.

Phase 2– High impact activity such as running or skating. Approx. 40 mins.

Phase 3– Sport specific non-contact activity.

Phase 4– Full controlled contact in a practice setting.

Phase 5– Return to full activities without restrictions

In order to advance through the phases the student must remain symptom free for 24 hours in between each phase. If the student regresses and becomes symptomatic during a phase, then they must rest until all symptoms have resolved and may start again on the last completed symptom free phase. The return to play is closely monitored by the Certified Athletic Trainer and documented daily.

The New York State law goes a step further then several other state laws in requiring coaches, physical education teachers, school nurses, and Certified Athletic Trainers to complete a biennial concussion training. The NYSPHSAA requires all caches and physical education teachers to complete the Centers for Disease Control and Prevention’s (CDC) “HEADS UP in Youth Sports” course and all school nurses and Certified Athletic Trainers to complete the CDC’s “HEADS UP for Clinicians” course. These can be found on the CDC’s website along with a concussion training course designed specifically for parents.

The “Concussion Management and Awareness Act” is vitally important in reducing the risk of concussions causing long-term damage and encourages parents, athletes, and coaches to take preventative steps to avoid serious head injury. Concussion management requires a collective effort among coaches, school administrators, and Certified Athletic Trainers along with parents/guardians to monitor an individual student’s recovery. The exact details of every school district’s concussion management protocol vary. For that reason it is a smart idea to familiarize yourself and your athlete with your district’s protocol.


Megan Smithuysen, LAT, ATC is the certified Athletic Trainer at Putnam Valley High School and works in the clinic at ProClinix Sports Physical Therapy & Chiropractic in Armonk. She can be reached at 914-202-0700. For more information, visit

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