1. Return to Play Guidelines for Junior Hockey in Marquette, MI
A concussionisa traumaticbrain injury- there is no such thing as a minor brain injury.
A player doesnot haveto be “knocked-out”tohavea concussion- less than10% of players
actually lose consciousness.
A concussion can result from a blow to head, neck or body. Concussions often occur to
players who don’t have or just released the puck, from open-ice hits, unanticipated hits
and illegal collisions.
The youth hockey player’s brain is more susceptible to concussion. In addition, the
concussionin a youngathlete may be harder to diagnosis, takeslonger to recover, is more
likely to have a recurrence and be associated with serious long-term effects.
This Policy applies to the youth athlete, as defined as an individual who participates in a
MJHC activity and who is under 18 years of age.
This concussion management protocol was created by Dr. Maggy Moore and the Athletic
Training Classof 2017 forMJHC.The group used theUSA Hockey ConcussionManagement
as a guideline in compliance with Michigan Concussion laws.
TheUSA Hockey Concussion ManagementProgramandPost-Concussion FunctionalReturn
to Play protocols were prepared by Drs. Michael Stuart and Alan Ashare. Additional
materials regarding concussion management are located on the USA Hockey website
(www.usahockey.com).
ManagementProtocol
1. If the player is unresponsive- call for help & dial 911
2. If the athlete is notbreathing:start CPR
 DO NOTmovethe athlete
 DO NOTremove the helmet
 DO NOTrushthe evaluation
3. Assume a neck injury untilprovenotherwise
 DO NOThave the athlete sit up or skateoff until youhavedetermined:
i. no neck pain
ii. no pain, numbnessortingling
iii. no midline neck tenderness
iv. normalmuscle strength
v. normalsensationto light touch

2. 4. If the athlete is conscious& responsivewithoutsymptomsorsignsof a neck injury…
 help the player off the ice to the locker room
 perform an evaluation
 do notleave them alone
5. Evaluate the player in the locker room:
 Ask aboutconcussionsymptoms(Howdoyoufeel?)
 Examine for signs
 Verify orientation(What day is it?, What is the score?, Whoare we playing?)
 If ImPACT(or any neurocognitivefunction) testing is availible, haveathlete takethe test.
 If not….
i. Check immediate memory (Repeat a list of 5 words)
ii. Test concentration(List the monthsinreverse order)
iii. Test balance (have the players standonbothlegs, one leg andone foor infront of
the other with their eyes closed for 20 seconds)
iv. Check delayedrecall (repeat the previous5 words after 5-10 minutes)
Signsof a concussionaccordingto the Heads-UpConcussionPrograminclude:
6. A playerdisplayinganyof the above symptomsorsignshasa concussion.
“When in doubt, sit them out.”
Anyathlete whosustainsaheadinjuryorshowssignsand symptomsof a concussionshouldbe
removedimmediatelyfromplay(training,practice,orgame) forthe remainderof the dayand
informthe parents.Until the athlete hasmedical clearance fromaqualifiedhealth-care
professional,the athlete isnot allowedtoreturntoplay.Keepinmindthatconcussionsymptoms&
SIGNS OBSERVED BY COACHING STAFF SYMPTOMS OBSERVED BY THE ATHLETE
 Appears dazedor stunned(glassy
eyes)
 Is confusedaboutplays or position
 Forgetsan instructionor play
 Is unsureof score or opponent
 Movesclumsily or has poorbalance
 Answers questionsslowly
 Loses consciousness, evenbriefly
 Demonstratesmood, behavior, or
personality changes
 Can’trecall events priorto hit or fall
 Can’trecall events after hit or fall
 Headache or “pressure” in head
 Nauseaor vomiting
 Balance problemsor dizziness
 Double or blurry vision
 Sensitivity to light or noise
 Feeling sluggish, hazy, foggy, or
groggy
 Difficulty concentrating
 Memory problems
 Doesn’t“feel right” or “feels down”

3. signsevolve overtime- the severityof the injuryandestimatedtime toreturntoplayare
unpredictable. Thisstatementcanbe readin the consensusstatementonconcussioninsportatthe
4th International Conference onConcussioninSportheldinZurich,November2012. “Same day RTP
It was unanimouslyagreedthatnoRTP onthe dayof concussive injuryshouldoccur.There are data
demonstratingthatatthe collegiateandhighschool levels,athletesallowedtoRTPonthe same day
may demonstrate neuropsychological deficitspost-injurythatmaynotbe evidentonthe sidelines
and are more likelytohave delayedonsetof symptoms.”
7. If any of the signsor symptomslistedbelow develop or worsen:go to the hospitalemergency
departmentor dial 911.
 Severe throbbingheadache
 Dizzinessor lossof coordination
 Memory lossor confusion
 Ringing in the ears (tinnitus)
 Blurred or doublevision
 Unequalpupil size
 Nopupil reaction to light
 Nauseaand/or vomiting
 Slurred speech
 Convulsionsortremors
 Sleepiness or grogginess
 Clear fluid runningfrom the nose and/orears
 Numbnessorparalysis(partial or complete)
 Difficulty in being aroused
8. An athlete who is symptomaticaftera concussion requires complete physicaland cognitive rest.
 Thoughbed rest may notbe possiblefor restless kids, strenuousactivity shouldbe
avoideduntil athlete is completely symptomfree, thentake the ImPACT(or other
neurocognitivefunction) test to be sure. Restriction from strenuousactivities include:
i. Nosports, noPE classes, andno leisure activities thatcould putthe child at risk
for second impact injury (skateboarding, climbing trees, bike riding, street pick-
up games)
 The child may havedifficulty concentrating, reasoningand learning andsuch activities
may aggravate concussionsymptoms. Thefollowing measuresshouldbe taken for
mental rest:
i. Time off from school, no homework, noreading, no visualstimulatingactivities
(computers, videogames, texting, or use of cell phones, andlimited or no
television), andincreased rest andsleep
9. The athlete cannotreturntoany sortof team participationin activities until MJHCrecieves
written authoriationfrom a qualified health-careprofessional. A copy of this authorizationmust
remain on file for the durationof the youthathlete’sparticipationwith MJCHor untilthe youthis
18 years old (See page 5).
10. Refer to the Post-ConcussionFunctionalReturntoPlay ProtocolsonPage 4 for further followup if
the athlete has sustaineda concussion. Understandthatrecovery may takelonger thanin adults
andrequire a more prolongedRTP progression(NationalAthletic Trainers’ Association Position
Statement:Managementof SportConcussion, April2014).

4. Date Accomplished
Reference:ConsensusStatementon Concussion in Sport:the4th
InternationalConferenceon Concussion
in Sportheld in Zurich (November2012), Br J of SportsMed 2013; 47:250–258. doi: 10.1136/bjsports-
2013-092313
1.
NO ACTIVITY
(RECOVERY)
Physical and
cognative rest
until medical
clearance
2.
LIGHT AEROBIC
EXERCISE
(INCREASE
Heart rate)
Walking,
swimming,
stationary
cycling.
3.
SPORT SPECIFIC
EXERCISE
(ADD
MOVEMENT)
Skatingdrills
NO headimpact
activities
4.
NONCONTACT
TRAINING
DRILLS
(INCREASED
EXERCISE,
COORDINATION
AND
ATTENTION)
Complex
TrainingDrills
(ex.Passing)
May start
resistance
training
5.
FULL CONTACT
PRACTICE
(RESTORE
CONFIDENCE
AND ACCESS
FUNCTIONAL
SKILLS)
If symptom
free,returnto
normal training
activities
Symptom Free for
24 Hours?
Yes:
Begin Step 2
No:
Continue
Resting
Symptom Free for
24 Hours?
Yes:
Move to Step 3
No:
Rest Further
until symptom
free
Symptom Free for
24 Hours?
Yes:
Move to Step 4
No:
Return to Step
2 until
symptom free
Symptom Free for
24 Hours?
Yes:
Move to Step 5
No:
Return to Step
3 until
symptom free
Symptom Free for
24 Hours?
Yes:
Return to Play
No:
Return to Step
4 until
symptom free
Date Accomplished Date AccomplishedDate Accomplished Date AccomplishedDate Accomplished
Gradual Return to Play Protocol
If any signsandsymptomsofconcussionshouldarise again while the
athlete is completing the phasesof return, they need to return to the
previousstep andbe reevaluated by a healthcare professional. Athlete
may progressagain when they are asymptomatic for 24 hours.