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IHSA Concussion Protocol

IHSA Protocol for Implementation of NFHS Sports Playing Rule for Concussions

“Any athlete who exhibits signs, symptoms, or behaviors consistent with a concussion (such as loss of consciousness, headache,

dizziness, confusion, or balance problems) shall be immediately removed from the contest and shall not return to play until cleared by an appropriate health care professional.”


The above language, which first appeared in all National Federation sports rule books for the 2010-11 school term, reflects a strengthening of rules regarding the safety of athletes suspected of having a concussion, but not a revision in primary responsibilities in these areas. Previous rules required officials to remove any athlete from play who was “unconscious or apparently unconscious.” This revised language reflects an increasing focus on safety, given that the vast majority of concussions do not involve a loss of consciousness. However, the revised language does not create a duty that officials are expected to perform a medical diagnosis. The change in rule simply calls for officials to be cognizant of athletes who display signs, symptoms, or behaviors of a concussion from the lists below and remove them from play.


NOTE: The persons who should be alert for such signs, symptoms, or behaviors consistent with a concussion in an athlete include appropriate health-care professionals, coaches, officials, parents, teammates, and, if conscious, the athlete him/herself.


Definition of a Concussion

A concussion is a traumatic brain injury that interferes with normal brain function. An athlete does not have to lose consciousness (be “knocked out”) to have suffered a concussion.


Behavior or signs observed indicative of a possible concussion

• Loss of consciousness

• Appears dazed or stunned

• Appears confused

• Forgets plays

• Unsure of game, score, or opponent

• Moves clumsily

• Answers questions slowly

• Shows behavior or personality changes

• Can’t recall events prior to or after the injury

Symptoms reported by a player indicative of a possible concussion

• Headache

• Nausea

• Balance problems or dizziness

• Double or fuzzy vision

• Sensitivity to light or noise

• Feeling sluggish

• Feeling foggy or groggy

• Concentration or memory problems

• Confusion


This protocol is intended to provide the mechanics to follow during the course of contests/matches/events when an athlete sustains an apparentconcussion. For the purposes of this policy, appropriate health care professionals are defined as: physicians licensed to practice medicine in all its branches in Illinois and certified athletic trainers.

1. During the pre-game conference of coaches and officials, the official shall remind the head coaches that a school-approved appropriate health care professional will need to clear for return to play any athlete removed from a contest for an apparent head injury.

2. The officials will have no role in determining concussion other than the obvious situation where a player is unconscious or apparently unconscious as is provided for under the previous rule. Officials will merely point out to a coach that a player is apparently injured and advise the coach that the player should be examined by the school-approved health care provider.

3. If it is confirmed by the school’s approved health care professional that the student did not sustain a concussion, the head coach may so advise the officials during an appropriate stoppage of play and the athlete may re-enter competition pursuant to the contest rules.

4. Otherwise, if an athlete cannot be cleared to return to play by a school-approved health care professional as defined in this protocol, that athlete may not be returned to competition that day and is then subject to the IHSA's Return to Play (RTP) Policy before the student-athlete can return to practice or competition.

5. Following the contest, a Special Report shall be filed by the contest official(s) with the IHSA Office through the Officials Center.

6. In cases where an assigned IHSA state finals event medical professional is present, his/her decision to not allow an athlete to return to competition may not be over-ruled.

Additional information regarding concussion has been made available to IHSA member schools and licensed officials and can be accessed on the IHSA Sports Medicine website at

5-Step Return to Play Progression

It is important for an athlete's parent(s) and coach(es) to watch for concussion symptoms after each day's return to play progression activity. An athlete should only move to the next step if they do not have any new symptoms at the current step. If an athlete’s symptoms come back or if he or she gets new symptoms, this is a sign that the athlete is pushing too hard. The athlete should stop these activities and the athlete’s medical provider should be contacted. After more rest and no concussion symptoms, the athlete can start at the previous step.

Baseline: Back to School First

Athlete is back to their regular school activities, is no longer experiencing symptoms from the injury when doing normal activities, and has the green-light from their health care provider to begin the return to play process.

Step 1: Light aerobic activity

Begin with light aerobic exercise only to increase an athlete’s heart rate. This means about 5 to 10 minutes on an exercise bike, walking, or light jogging. No weight lifting at this point.

Step 2: Moderate activity

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, moderate-intensity weightlifting (less time and/or less weight from their typical routine).

Step 3: Heavy, non-contact activity

Add heavy non-contact physical activity, such as sprinting/running, high-intensity stationary biking, regular weightlifting routine, non-contact sport-specific drills (in 3 planes of movement).


Step 4: Practice & full contact

Young athlete may return to practice and full contact (if appropriate for the sport) in controlled practice.

Step 5: Competition

Young athlete may return to competition.