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Effective concussion management for athletic trainers relies on using validated sideline assessment tools like the SCAT-5/SCAT-6, supplemented by standardized symptom inventories and Vestibular/Ocular Motor Screening (VOMS) for multidimensional evaluation. Trainers should also utilize professional educational resources such as CDC HEADS UP to stay updated on management protocols and recovery processes like Return-to-Learn and Return-to-Play steps.
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Named in 53% of answers
Named in 34% of answers
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Source | Citation share |
|---|---|
 National Athletic Trainers' Association Position Statement - PMChttps://pmc.ncbi.nlm.nih.gov/articles/PMC3975780/ | 5.5% |
 CONCUSSION MANAGEMENT PROTOCOL - University of Houston Athleticshttps://uhcougars.com/sports/2018/6/12/ot-sportsmed-concussion-html | 3.8% |
 Responding to a Sports-related Concussion | HEADS UP | CDChttps://www.cdc.gov/heads-up/response/index.html | 3.5% |
 Role of Athletic Trainers for Concussion Carehttps://impacttest.com/why-athletic-trainer-concussion-infographic/ | 3.2% |
 Management of Sport Concussion - NATAhttps://www.nata.org/sites/default/files/2025-08/management_of_sport_concussion.pdf | 2.7% |
National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion - PMChttps://pmc.ncbi.nlm.nih.gov/articles/PMC522153/ | 2.6% |
Athletic Trainers' Concussion-Assessment and Concussion-Management Practices: An Update - PMChttps://pmc.ncbi.nlm.nih.gov/articles/PMC6961637/ | 2.4% |
 Athletic Trainers Role in Concussion Management | HEADCHECK Healthhttps://www.headcheckhealth.com/athletic-trainers-concussion-management/ | 2.0% |
Concussion in Sports: The Sideline Assessment - PMChttps://pmc.ncbi.nlm.nih.gov/articles/PMC3445181/ | 1.9% |
 Concussion Protocol - St. Charles Health Systemhttps://stcharleshealthcare.org/services/center-orthopedics-and-neurosurgery/concussion-center/concussion-protocol | 1.8% |
For athletic trainers (ATs), the gold standard for concussion assessment and management is guided by the **NATA Position Statement on Management of Sport Concussion** and the international consensus standards from the **[Concussion in Sport Group (CISG) Amsterdam Consensus…
For athletic trainers (ATs), the gold standard for concussion assessment and management is guided by the NATA Position Statement on Management of Sport Concussion and the international consensus standards from the Concussion in Sport Group (CISG) Amsterdam Consensus Statement.
An effective, evidence-based protocol follows a comprehensive, multi-modal lifecycle from pre-season preparation to full clearance.
Before the first whistle of the competitive season, establish baseline metrics for high-risk or contact-sport athletes.
When a concussion is suspected on the field, the primary rule is immediate removal from play.
Perform a comprehensive clinical evaluation utilizing standardized multi-modal tools:
Manage the acute phase with a brief period (24–48 hours) of relative physical and cognitive rest, followed by active, individualized rehabilitation.
If you'd like to tailor this further, let me know:
A strong concussion protocol for an athletic trainer (AT) should be **evidence-based, athlete-centered, and built around early recognition, removal from play, clinical assessment, symptom-guided treatment, and a graduated return-to-sport process**. Current best practices are based largely on the Concussion in Sport…
A strong concussion protocol for an athletic trainer (AT) should be evidence-based, athlete-centered, and built around early recognition, removal from play, clinical assessment, symptom-guided treatment, and a graduated return-to-sport process. Current best practices are based largely on the Concussion in Sport Group Amsterdam 2022 consensus and updated athletic training guidance from the National Athletic Trainers' Association.
Below is a practical protocol framework an AT can adapt with team physicians and organizational policies.
Before the season begins:
Potential baseline components:
Activate emergency procedures for:
The initial assessment should include:
Document:
Include:
Common tools:
Assessment tools support—but do not replace—the AT’s clinical judgment.
Management should avoid both extremes:
Recommended approach:
Monitor:
Follow-up assessments should track:
Treatment should be individualized.
Examples:
Consider referral to specialists such as:
Before full return to sport, the athlete should be progressing academically.
Possible accommodations:
Each step generally requires at least 24 hours, and the athlete should return to the previous step if symptoms worsen.
Examples:
Goal:
Examples:
No contact.
Examples:
Begin restoring coordination and cognitive load.
Only after:
The athlete returns only when medically appropriate.
Document:
Good documentation is essential for continuity of care and legal/medical standards.
A complete program should also be aligned with your state concussion law, school/league policy, and supervising physician’s standing orders, since requirements vary by setting.
The gold standard for concussion assessment and management is guided by the **Amsterdam International Consensus Statement on Concussion in Sport (SCAT6/SCOAT6 framework)** and aligned with the [CDC HEADS UP to Athletic Trainers Training](https://www.cdc.gov/heads-up/training/athletic-trainers.html) developed in…
The gold standard for concussion assessment and management is guided by the Amsterdam International Consensus Statement on Concussion in Sport (SCAT6/SCOAT6 framework) and aligned with the CDC HEADS UP to Athletic Trainers Training developed in conjunction with the National Athletic Trainers' Association (NATA).
The modern protocol emphasizes the "11 R's" of concussion management, structured around immediate removal, multi-modal evaluation, active recovery, and individualized return-to-learn/return-to-play progressions.
If you're looking to tailor this for a specific setting, tell me:
For an athletic trainer, the best current approach is a **multimodal, stepwise concussion protocol** based primarily on the **6th International Consensus Statement (Amsterdam 2022)**, the **2024 NATA Bridge Statement**, and current **CDC HEADS UP** guidance.…
For an athletic trainer, the best current approach is a multimodal, stepwise concussion protocol based primarily on the 6th International Consensus Statement (Amsterdam 2022), the 2024 NATA Bridge Statement, and current CDC HEADS UP guidance.
Your program should have a written concussion-management plan that specifies:
Baseline testing can be useful, but it should not be treated as a diagnostic test or a prerequisite for diagnosing concussion. The 2022 consensus specifically cautions against using computerized neurocognitive testing in isolation.
If concussion is suspected:
Remove the athlete from play immediately.
Do not allow the athlete to return to play the same day if concussion is suspected. The athlete should undergo an appropriate medical evaluation.
Think:
Recognize → Remove → Rule out emergency → Assess → Refer/monitor → Rehabilitate → Gradual return Do not try to determine whether the athlete is "just shaken up" while allowing continued participation.
Immediately assess the athlete's overall condition and perform an appropriate primary survey.
Activate emergency medical services / emergency referral for concerning findings such as:
If cervical-spine injury is possible, manage the cervical spine appropriately rather than simply sitting the athlete upright.
For an athlete with suspected sport-related concussion, use a multimodal assessment, rather than relying on one symptom, balance test, or cognitive test.
The current international tools are:
These tools were specifically developed as part of the Amsterdam consensus process.
A practical AT assessment should include:
Document:
Assess symptoms across domains including:
Assess appropriate aspects of:
Depending on your training/scope and clinical setting:
Use an appropriate standardized balance assessment.
When clinically appropriate, assess areas such as:
The Amsterdam consensus emphasizes that concussion recovery should be evaluated using symptoms plus relevant clinical/functional findings, rather than a single test.
Neurocognitive testing can provide useful information, particularly when incorporated into a broader assessment, but a normal computerized test does not rule out concussion, and an abnormal score alone should not determine management.
The international consensus specifically states that computerized neurocognitive results should be interpreted within the broader clinical picture.
One of the most important changes from older concussion protocols is that strict physical and cognitive rest until completely symptom-free is no longer recommended.
For roughly the first 24–48 hours, use relative rest:
After the initial 24–48 hours, early light physical activity below the symptom-exacerbation threshold is generally encouraged.
The athlete should have an individualized return-to-school/academic plan.
Progress cognitive activity according to symptoms rather than requiring complete symptom elimination before returning to school.
The CDC recommends that concussion management consider both cognitive and physical activity and be individualized to the athlete.
For a student-athlete, coordinate with:
Rather than simply waiting for symptoms to disappear, treatment can target the athlete's specific impairments.
Examples include:
The consensus statement recommends cervicovestibular rehabilitation when dizziness, neck pain, or headaches persist beyond approximately 10 days, and active rehabilitation/collaborative care for persistent symptoms, particularly when symptoms continue beyond four weeks.
Once medically appropriate, use a graduated progression. Each stage generally takes at least 24 hours, and the athlete should only advance if symptoms do not worsen beyond an acceptable threshold.
The CDC's current six-step progression is:
The CDC recommends healthcare-provider approval/supervision for return to sport, with each step typically requiring a minimum of 24 hours.
An important nuance from Amsterdam: steps involving meaningful risk of head impact should not occur until concussion-related symptoms, cognitive abnormalities, and relevant clinical findings have resolved and the athlete has successfully tolerated physical exertion.
If symptoms recur during progression, stop/step back, reassess, and modify the workload rather than pushing through.
Before unrestricted contact/competition, the athlete should meet your jurisdiction's and organization's requirements for medical clearance.
A good final assessment considers:
The decision should be clinical and individualized, not simply "the SCAT is normal."
Suspected concussion
↓
Remove from play
↓
Primary survey + cervical-spine consideration + emergency red flags
↓
Emergency referral if red flags are present
↓
Multimodal concussion assessment
↓
No same-day return to play
↓
Medical evaluation/diagnosis and individualized management
↓
24–48 h relative rest
↓
Return to daily activity / return to learn
↓
Early subsymptom aerobic activity
↓
Progressive rehabilitation
↓
Graduated RTS: 1 → 2 → 3 → 4 → 5 → 6
↓
Medical clearance before unrestricted contact/competition
↓
Full return
If I were building an athletic-training protocol today, I would use the Amsterdam 2022 SCAT6/SCOAT6 framework + 2024 NATA recommendations + CDC's current six-step RTS progression, while incorporating your state's concussion law, school/league rules, and physician medical-directive structure. This is preferable to older protocols centered on prolonged strict rest, serial symptom scores alone, or mandatory neurocognitive testing.
If you're developing this for an athletic training room, high school, college, or sports medicine clinic, I can also lay this out as a one-page sideline concussion assessment and management algorithm, including exactly what the AT should document at each stage.
Yes. I reviewed the current **CDC HEADS UP guidance, the 2022 Amsterdam International Consensus Statement, and the National Athletic Trainers’ Association (NATA) guidance**. For an athletic trainer, the best approach is a **standardized, multimodal concussion protocol** rather than relying on a single test or symptom…
Yes. I reviewed the current CDC HEADS UP guidance, the 2022 Amsterdam International Consensus Statement, and the National Athletic Trainers’ Association (NATA) guidance. For an athletic trainer, the best approach is a standardized, multimodal concussion protocol rather than relying on a single test or symptom checklist. The Amsterdam consensus specifically emphasizes that SCAT6 is an acute assessment tool and that concussion management should be individualized and multidisciplinary.
Important: This is a clinical framework, not a substitute for your institution's physician-approved concussion policy, state law, or your scope of practice.
Have a written concussion management plan that establishes:
The CDC specifically recommends that athletic trainers understand applicable state, league, and governing-body requirements before the season.
The CDC and NATA also offer a dedicated HEADS UP to Athletic Trainers training program covering prevention, evaluation, management, documentation, and return-to-school/sport.
Consider concussion after a blow to the head or a force transmitted to the head/body, particularly when the athlete develops:
Symptoms can evolve over minutes, hours, or days, so an initially normal examination does not necessarily exclude concussion.
If concussion is suspected:
Remove the athlete from play immediately.
Do not allow the athlete to "shake it off," return for the next play, or use a quick sideline test to justify continued participation.
The CDC's current guidance is explicit: suspected concussion → remove from sports → evaluate for danger signs → no same-day return to sports → medical evaluation.
If there is a suspected cervical spine injury, significant neurological abnormality, or other potentially serious injury, manage that first according to your emergency protocols.
Immediately activate EMS/emergency evaluation for concerning findings such as:
These are potential signs of a more serious brain injury rather than simply an uncomplicated concussion.
For an acute suspected concussion, SCAT6 is the current standardized tool recommended by the Amsterdam consensus.
The evaluation should not be just "How many symptoms do you have?"
A good athletic-trainer assessment incorporates:
| Domain | Examples |
|---|---|
| Symptoms | Severity, number, trajectory |
| Cognition | Orientation, immediate/delayed memory, concentration |
| Neurologic | Cranial nerves, motor/sensory function, coordination |
| Balance | Tandem stance/gait and balance testing |
| Vestibular/ocular | Eye movements, VOR, symptom provocation |
| Cervical | ROM, tenderness, associated neck symptoms |
| Behavior | Affect, confusion, responsiveness |
| Exertion | Later, symptom response to controlled activity |
| Injury history | Mechanism, previous concussion, relevant modifiers |
The Amsterdam consensus specifically recommends a multimodal clinical assessment rather than depending on computerized neurocognitive testing or any single examination component. Computerized cognitive testing should not be used alone to make diagnosis or return-to-play decisions.
SCAT6 is most useful during the acute period—roughly the first 72 hours and up to about 5–7 days. After the acute period, the SCOAT6 is designed for more comprehensive subacute assessment beginning around 72 hours after injury.
Document contemporaneously:
Documentation is particularly important because concussion findings can change over time.
The athlete should receive evaluation by an appropriately qualified healthcare provider for suspected concussion.
For the athletic trainer, the key distinction is:
The AT identifies, evaluates, manages, monitors, and coordinates care within scope—but the exact authority for diagnosis and medical clearance depends on state law, institutional policy, and the athlete's medical team.
The CDC recommends specialist referral when symptoms worsen, fail to resolve within 2–4 weeks, or when there are multiple concussions or other risk factors for prolonged recovery.
Persistent symptoms should prompt a multimodal assessment, potentially involving sports medicine, vestibular/cervical rehabilitation, neurology, neuropsychology, physical therapy, or other appropriate specialists.
One of the most important updates from the Amsterdam consensus is that strict physical and cognitive rest until symptom-free is no longer recommended.
Instead:
Use relative rest:
After approximately 24–48 hours, begin light physical activity as tolerated rather than keeping the athlete completely inactive.
Symptoms can increase mildly and briefly during activity; the consensus uses an increase of no more than about 2 points on a 0–10 scale, with symptoms settling within approximately an hour, as a practical threshold for continuing progression.
For student-athletes, return-to-learn should occur alongside physical recovery.
The goal isn't necessarily "zero symptoms before going to school."
Instead, progressively restore:
Appropriate accommodations can include reduced screen exposure, rest breaks, reduced workload, modified attendance, additional time, or delayed testing.
The Amsterdam consensus considers return-to-learn particularly important in children, adolescents, and young adults.
The current progression is:
Step 1 — Symptom-limited activity
Normal daily activities; gradual reintroduction of activity.
Step 2A — Light aerobic exercise
Walking, stationary bike, light jogging.
Step 2B — Moderate aerobic exercise
More vigorous aerobic activity.
Step 3 — Individual sport-specific exercise
Sport-specific movement without head-impact risk.
Step 4 — Non-contact training
More intense training, resistance exercise, complex movement.
Step 5 — Full-contact practice
Only after appropriate medical authorization.
Step 6 — Competition
Each step generally requires at least 24 hours, and progression is based on symptoms and clinical findings—not simply completing a predetermined number of days.
The CDC's current six-step progression similarly requires healthcare-provider approval and recommends stopping/reducing progression if new or worsening symptoms occur.
Don't interpret "6 steps" as "six days."
An athlete may take considerably longer, and later stages involving contact/collision require medical authorization. The Amsterdam consensus estimates that unrestricted return to sport commonly occurs within a month, but individual recovery varies substantially.
Suspected concussion
↓
Remove from play
↓
Primary assessment / emergency screening
↓
Danger signs?
YES → EMS / emergency department
NO → continue assessment
↓
SCAT6 + multimodal clinical examination
↓
Suspected concussion?
YES → no same-day return + medical evaluation + instructions
↓
24–48 h relative rest
↓
Early symptom-limited physical activity
↓
Serial symptom + clinical reassessment
↓
Return-to-learn
↓
Graduated return-to-sport
↓
Medical authorization before risk-of-impact stages
↓
Full practice → competition
↓
Continue monitoring / reassess if symptoms recur
This is essentially the modern Recognize → Remove → Re-evaluate → Rest/Exercise → Rehabilitate → Return-to-Learn → Return-to-Sport model advocated by the international consensus.
For an athletic-training program, I'd base the written protocol on three layers:
If you're an AT developing an actual school/team concussion protocol, I can also lay this out as a one-page sideline concussion algorithm + detailed evaluation form + 6-step RTP flowchart, which is probably the most practical format for clinical use.
For an athletic trainer (AT), the gold standard for concussion assessment and management follows a multi-modal, evidence-based approach aligned with the National Athletic Trainers’ Association (NATA) Position Statement and the international consensus framework from the [Concussion in Sport Group (CISG) Amsterdam…
For an athletic trainer (AT), the gold standard for concussion assessment and management follows a multi-modal, evidence-based approach aligned with the National Athletic Trainers’ Association (NATA) Position Statement and the international consensus framework from the Concussion in Sport Group (CISG) Amsterdam Consensus Statement.
Because no single test can reliably diagnose a concussion, a comprehensive multi-domain battery is required.
Phase 1: Recognition and Immediate Sideline Evaluation (< 72 Hours)
Phase 2: Subacute Tracking and Management (24–48 Hours to Weeks)
Phase 3: Graduated Return-to-Sport (RTS) Progression
Do not clear an athlete based on a single normal test score . The athlete must be completely symptom-free at rest and during physical exertion before final medical clearance (which requires physician sign-off depending on state/institutional mandates). Follow a stepwise progression (each step taking a minimum of 24 hours):
Would you like to explore baseline testing software options or details on how to manage prolonged/persistent post-concussive symptoms?
The best concussion assessment and management protocol for a certified athletic trainer (AT) is a **multifaceted, multidimensional approach** aligned with the National Athletic Trainers’ Association (NATA) Position Statement and the latest [International Consensus Statement on Concussion in…
The best concussion assessment and management protocol for a certified athletic trainer (AT) is a multifaceted, multidimensional approach aligned with the National Athletic Trainers’ Association (NATA) Position Statement and the latest International Consensus Statement on Concussion in Sport . This gold-standard model relies on immediate removal from play ("when in doubt, sit them out"), a 3-domain minimum assessment battery (symptom, balance, and neurocognitive testing), structured return-to-learn and graduated return-to-play progressions, and mandatory physician medical clearance.
Phase 1: Preseason Preparation
Phase 2: Acute Sideline Evaluation
Phase 3: Referral and Early Rest (First 24–48 Hours)
Phase 4: Graduated Management & Progressions
If you would like, I can provide:
For an athletic trainer, the best current approach is a **multimodal, remove-and-refer protocol based on the Amsterdam 2022 International Consensus Statement, SCAT6/SCOAT6, CDC HEADS UP guidance, and the 2024 NATA Bridge Statement**. The key principle is: **when concussion is suspected, remove the athlete immediately,…
For an athletic trainer, the best current approach is a multimodal, remove-and-refer protocol based on the Amsterdam 2022 International Consensus Statement, SCAT6/SCOAT6, CDC HEADS UP guidance, and the 2024 NATA Bridge Statement. The key principle is: when concussion is suspected, remove the athlete immediately, rule out a more serious injury, and do not allow same-day return to play.
Suspect concussion after a blow to the head or body when there are new symptoms, signs, or behavioral/cognitive changes.
Common findings include:
Remove the athlete from play immediately. Do not let the athlete "play through it" or use symptom improvement as justification for returning that day.
Perform your emergency assessment according to your EAP and scope of practice.
Emergency referral is warranted for findings such as:
These are not simply "concussion symptoms" to monitor on the sideline; they raise concern for a more serious intracranial or cervical injury and require emergency evaluation.
If the athlete is medically stable, use the SCAT6 as your principal standardized acute assessment. It is designed for the first 72 hours and up to approximately 1 week after injury.
Your evaluation should include:
History
Physical/neurologic examination
Concussion-specific domains
Importantly, no single test rules concussion in or out. Computerized neurocognitive testing should not be used in isolation to make the diagnosis or return-to-play decision.
If you have preseason baseline testing, use it as one piece of the clinical picture, not as a pass/fail diagnostic test.
A "normal" computerized cognitive score does not mean the athlete isn't concussed, and an abnormal baseline comparison isn't by itself diagnostic.
The athlete should receive evaluation by an appropriately qualified healthcare provider.
For a suspected concussion:
No same-day return to play.
The athletic trainer can perform the initial assessment and manage the athlete within their scope, but medical clearance requirements depend on the athlete's jurisdiction, age, sport, governing body, and institutional policy. CDC guidance likewise recommends that athletes remain out of sports participation until cleared by a healthcare provider.
Also check your state law, school/college policy, athletic association rules, and physician-directed concussion protocol because these can impose additional requirements.
One of the biggest changes from older concussion protocols is that strict physical and cognitive rest until symptom-free is no longer recommended.
For approximately the first 24–48 hours:
The Amsterdam consensus specifically recommends relative rest rather than complete sensory/cognitive isolation.
After the initial 24–48 hours, subsymptom-threshold aerobic activity is therapeutic, rather than waiting for complete symptom resolution before exercising.
For example:
The exercise should remain below the level that causes more than mild, transient symptom exacerbation.
If symptoms worsen substantially, reduce the intensity/duration and reassess. The Amsterdam consensus found good evidence supporting early aerobic exercise as part of concussion treatment.
For student-athletes, return-to-learn (RTL) should occur alongside recovery, rather than keeping the athlete completely out of school until every symptom disappears.
Potential temporary accommodations include:
The athlete should ultimately be able to tolerate normal academic activities before completing the final stages of return-to-sport.
Once clinically appropriate, use the Amsterdam 6-step RTS progression. Each step generally requires at least 24 hours.
| Step | Activity |
|---|---|
| 1. Symptom-limited activity | Daily activities; gradual reintroduction of normal activity |
| 2A. Light aerobic exercise | Walking, light cycling |
| 2B. Moderate aerobic exercise | More vigorous aerobic activity |
| 3. Individual sport-specific exercise | Sport-specific movement, but no head-impact risk |
| 4. Non-contact training | More complex training, resistance exercise, coordination |
| 5. Full-contact practice | Normal training after medical authorization |
| 6. Return to sport | Normal competitive play |
The important nuance is that Steps 1–3 can function as treatment during early recovery, while the later stages progressively reintroduce sport-specific and contact/collision risk.
If symptoms meaningfully worsen during a step:
The athlete doesn't necessarily need to return to complete rest after every tiny symptom fluctuation; the response should be individualized according to symptom severity and clinical judgment.
Medical authorization should occur before the athlete enters stages involving risk of contact, collision, or falling, and before unrestricted return, consistent with local regulations and institutional policy.
Concussion is an evolving injury. A good AT protocol includes serial assessments.
Track:
For assessments beginning approximately 72 hours after injury, the SCOAT6 is designed specifically to provide a more comprehensive office/subacute evaluation and can be used for serial follow-up.
If specific deficits persist, treatment should be targeted.
Examples:
Dizziness/vestibular problems → vestibular or cervicovestibular rehabilitation
Neck pain/headache → cervical assessment and appropriate rehabilitation
Exercise intolerance → structured subsymptom aerobic exercise
Persistent cognitive/academic problems → RTL modifications and appropriate referral
Mood/psychological symptoms → appropriate mental-health evaluation/support
If symptoms are worsening, failing to progressively improve, or persisting beyond approximately 2–4 weeks, a multimodal evaluation and referral to clinicians experienced in concussion management are appropriate.
Suspected concussion →
REMOVE FROM PLAY
↓
Emergency assessment / cervical-spine considerations
↓
Identify red flags → ED/emergency referral if present
↓
SCAT6 / multimodal clinical assessment
↓
No same-day return
↓
Medical evaluation + written instructions
↓
24–48 h relative rest
↓
Early, symptom-limited physical activity
↓
Return-to-learn + symptom management
↓
Progressive aerobic → sport-specific → noncontact → contact → competition
↓
Serial reassessment at every stage
↓
Medical clearance before risk-of-contact stages as required
↓
Full return when symptom-free, clinically recovered, and functionally ready
The 2024 NATA Bridge Statement is particularly useful for an athletic trainer because it translates newer concussion evidence into AT practice, including assessment, prognostic factors, mental health, academics, exercise, rehabilitation, and RTS.
If you're building this for actual athletic-trainer clinical use, I can also lay it out as a one-page sideline concussion assessment + management checklist, including exactly what to document, SCAT6 components, red flags, and the 6-step RTS criteria.
For an athletic trainer, the best current approach is a **multimodal, stepwise concussion protocol based on the Amsterdam 2022 International Consensus, SCAT6/SCOAT6, CDC guidance, and your state/school/league medical policy**. The key change from older protocols is that **strict “cocoon” rest is no longer…
For an athletic trainer, the best current approach is a multimodal, stepwise concussion protocol based on the Amsterdam 2022 International Consensus, SCAT6/SCOAT6, CDC guidance, and your state/school/league medical policy. The key change from older protocols is that strict “cocoon” rest is no longer recommended; relative rest followed by early, symptom-limited activity is preferred.
If concussion is suspected, remove the athlete from play immediately.
Look for:
Do not let the athlete return to play the same day if concussion is suspected. CDC guidance specifically recommends removal from sports and evaluation by a healthcare professional before return.
Do not use “he looks fine” as the clearance criterion. Symptoms can evolve over minutes, hours, or days.
Before doing a full concussion assessment, determine whether this could be a more serious traumatic brain or cervical-spine injury.
Emergency referral/EMS is indicated for red flags such as:
These are reasons for immediate medical assessment rather than continuing a sideline concussion evaluation.
If cervical-spine injury is possible, manage the athlete according to your spinal-injury/EAP protocol and avoid unnecessary movement.
For a trained healthcare professional, SCAT6 is the appropriate standardized acute tool, particularly during the first 72 hours and up to approximately 1 week after injury.
The assessment should be multimodal, rather than simply administering a symptom checklist.
A practical sequence is:
A. Injury history
B. Observable signs
C. Symptom evaluation Assess severity of symptoms such as:
D. Cognitive assessment Include orientation, immediate memory, concentration and delayed recall as appropriate within SCAT6.
E. Neurologic examination Assess cranial/neurologic function and look for focal abnormalities.
F. Balance/gait Assess balance and gait according to the SCAT6 protocol.
The SCAT6 itself emphasizes that an abbreviated screen may be inadequate; a proper multimodal assessment generally takes 10–15 minutes or more and should preferably occur away from the pressure and distraction of competition.
If the athlete has a suspected concussion:
Remove → assess → document → refer/notify → monitor → no same-day return.
The athlete should be evaluated by an appropriate healthcare professional who can diagnose and manage concussion. The athletic trainer's role and authority will depend on state law, institutional policy, physician standing orders, and the athlete's healthcare team. CDC specifically emphasizes that return-to-sport is a healthcare-provider decision.
Provide the athlete/family with:
Also document the event thoroughly.
The current evidence does not support strict physical and cognitive rest until symptom-free.
For approximately the first 24–48 hours:
After 24–48 hours, begin progressively increasing activity based on symptoms.
A useful clinical principle is:
Mild, brief symptom exacerbation can be acceptable; substantial or prolonged worsening means the activity was too much.
Modern concussion management is not simply “wait until symptoms disappear.”
Depending on the presentation, consider:
For example, persistent dizziness, neck pain, headaches, or balance problems may warrant cervicovestibular rehabilitation. The Amsterdam consensus specifically recommends targeted rehabilitation rather than simply waiting for persistent symptoms to resolve.
For student-athletes, return-to-learn (RTL) should be part of the concussion plan, not an afterthought.
Initially, the athlete may need:
The goal is progressive return to normal academics rather than prolonged complete school avoidance. The CDC and Amsterdam consensus support early, symptom-limited return to normal activities.
Once medically appropriate, use a graduated 6-step progression.
| Step | Activity |
|---|---|
| 1. Symptom-limited activity | Normal daily activities; gradual reintroduction of routine |
| 2A. Light aerobic | Walking, easy cycling, light aerobic exercise |
| 2B. Moderate aerobic | Moderate cycling/jogging; increased intensity |
| 3. Individual sport-specific | Sport-specific movement, but no head-impact risk |
| 4. Non-contact training | Higher-intensity training, resistance training, complex drills |
| 5. Full-contact practice | Normal practice after appropriate medical clearance |
| 6. Competition | Full return to competition |
Each step should generally take at least 24 hours. If symptoms meaningfully recur, stop, allow recovery, and return to the previous tolerated level rather than pushing through.
Steps involving meaningful risk of head impact should not begin until the athlete has complete symptom resolution and appropriate medical authorization.
The Amsterdam consensus distinguishes early therapeutic exercise from the later stages that expose the athlete to contact/collision risk.
Baseline and post-injury neurocognitive testing can be useful as one piece of the puzzle, but it should never be the sole basis for diagnosing concussion or clearing an athlete.
The Amsterdam consensus specifically states that computerized neurocognitive testing should be interpreted within the broader clinical assessment and not used in isolation.
Likewise, routine CT/MRI isn't necessary for diagnosing an uncomplicated concussion; imaging is primarily used when there is concern for a more serious intracranial injury.
A good AT protocol includes scheduled reassessment rather than a single evaluation.
Consider specialist referral when:
The Amsterdam consensus recommends multimodal assessment and rehabilitation for symptoms persisting beyond 4 weeks, while CDC guidance recommends considering specialist referral when symptoms worsen, persist beyond 2–4 weeks, or there is a history suggesting increased risk of prolonged recovery.
Suspected concussion
↓
Remove from play
↓
Emergency/red-flag + cervical-spine assessment
↓
SCAT6 multimodal assessment
↓
Suspected/confirmed concussion → NO same-day return
↓
Notify athlete/parents/coaches + medical provider
↓
Written instructions + serial monitoring
↓
24–48 h relative rest
↓
Early symptom-limited physical activity
↓
Individualized rehabilitation + return-to-learn
↓
Graduated return-to-sport
↓
Medical clearance before contact-risk activity
↓
Full-contact practice
↓
Competition
If you're developing an actual school/college athletic-training protocol, I'd build it around these four documents:
The 2025 NATA bridge statement is also particularly relevant to athletic trainers because it updates the older NATA concussion position statement in light of newer evidence, including assessment, prognostic factors, mental health, academics, exercise, rehabilitation, and return to sport.
Important: This should supplement—not replace—your supervising physician's orders, emergency action plan, state concussion law, and school/league policy. Those requirements can be more restrictive than the general clinical recommendations above.
The gold standard for concussion assessment and management for certified athletic trainers (ATs) aligns with the National Athletic Trainers’ Association (NATA) Position Statements and Bridge Guidelines , which reflect the latest International Consensus Statement on Concussion in Sport (SCAT6…
The gold standard for concussion assessment and management for certified athletic trainers (ATs) aligns with the National Athletic Trainers’ Association (NATA) Position Statements and Bridge Guidelines , which reflect the latest International Consensus Statement on Concussion in Sport (SCAT6 framework).
Strict "cocooning" or complete physical/cognitive rest is no longer supported by evidence. Modern management emphasizes early, symptom-limited active recovery.
Progression through stepwise loading should be individualized, symptom-guided, and managed in close coordination with a supervising physician and an interdisciplinary school team:
If you're working with a specific demographic (such as youth/adolescent athletes or collegiate/tactical populations ), I can provide more tailored guidance on utilizing baseline testing batteries or coordinating academic accommodation letters.
