Concussion in Sports in Pakistan: Symptoms, Causes & Treatment | aihealz
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Concussion in Sports.Care & specialists in Pakistan
In Pakistan, concussion in Sports is managed by sports medicines. Sport-related concussion is a traumatic brain injury caused by biomechanical forces transmitted to the brain that produces transient neurological dysfunction without macroscopic structural injury on standard imaging. US emergency departments treat approximately 1.7-3 million sport-related concussions per year and total annual incidence including unreported cases is estimated at 3.8 million.
aliases · Concussion in Sports (sport-related mild traumatic brain injury)· Conmoción cerebral deportiva· Commotion cérébrale sportive· खेल में मस्तिष्क आघात· reviewed May 14, 2026
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Reviewed by AIHealz Medical Editorial Board · Sports MedicineLast reviewed May 13, 2026
Sport-related concussion (ICD-10: S06.0X0A through S06.0X9S depending on duration of loss of consciousness and encounter type) is defined by the 6th International Consensus Statement on Concussion in Sport (Amsterdam 2022) as a traumatic brain injury caused by a direct blow to the head, neck, or body with an impulsive force transmitted to the brain, occurring in sport and exercise-related activities and producing transient neurological signs or symptoms. The diagnosis is clinical and does not require structural imaging changes; standard CT and MRI are typically normal. Pathophysiology involves a neurometabolic cascade with potassium efflux, glutamate release, calcium influx, mitochondrial dysfunction, decreased cerebral blood flow, and axonal stretch injury that produces functional but not macroscopic structural damage. Concussion is one form of mild traumatic brain injury and the terms are often used interchangeably in sport medicine.
key facts
Prevalence
Approximately 1.7-3 million sport-related concussions treated in US emergency departments annually; total incidence including unreported cases estimated at 3.8 million (CDC)
Demographics
Highest rates in male football, ice hockey, rugby, and lacrosse; female athletes have higher concussion rates than males in equivalent sports (soccer, basketball), with longer recovery times in many studies
Avg. age
Peak incidence age 14-19 years in organized sports; pediatric and adolescent athletes have longer recovery than adults
Global cases
Estimated tens of millions of sport-related concussions annually worldwide; reporting and surveillance remain incomplete
Specialist
Sports Medicine
§ 02
How you might notice it
The key symptoms of Concussion in Sports are: Confusion, disorientation, or a 'dazed' look at the time of impact; brief memory disturbance (retrograde or anterograde amnesia) for events around the injury., Headache, often described as pressure or dull, sometimes throbbing — present in 80-90% of cases., Dizziness, lightheadedness, or feeling 'off-balance' — second most common symptom and a marker of vestibular involvement., Nausea or vomiting, especially in the first few hours after injury., Sensitivity to light (photophobia) and noise (phonophobia), often persisting for days., Slowed thinking, difficulty concentrating, mental fogginess, and decreased reaction time on cognitive testing., Sleep disturbance — early difficulty initiating sleep, then often hypersomnia followed by insomnia or fragmented sleep..
01Confusion, disorientation, or a 'dazed' look at the time of impact; brief memory disturbance (retrograde or anterograde amnesia) for events around the injury.
02Headache, often described as pressure or dull, sometimes throbbing — present in 80-90% of cases.
03Dizziness, lightheadedness, or feeling 'off-balance' — second most common symptom and a marker of vestibular involvement.
04Nausea or vomiting, especially in the first few hours after injury.
05Sensitivity to light (photophobia) and noise (phonophobia), often persisting for days.
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How it’s diagnosed
diagnosis
Diagnosis is clinical, made at the side of play and refined over the following hours and days. The on-field assessment begins by removing the athlete from competition any time concussion is suspected; the Maddocks-style orientation questions ('What venue are we at? Which half is it? Who scored last? What team did you play last week? Did your team win the last game?') screen for cognitive impairment. The Sport Concussion Assessment Tool 6th edition (SCAT6) is the most widely used on-field and clinic instrument and incorporates symptom checklist, cognitive testing (orientation, immediate and delayed memory, concentration), neurological screening, balance testing (modified BESS), and tandem gait. Pediatric athletes ages 8-12 use the Child SCAT6 and ages 5-12 the optimized pediatric tool. Imaging (CT or MRI) is reserved for any sign of more severe injury (focal deficit, suspected skull fracture, prolonged loss of consciousness, vomiting, anticoagulation use). The Canadian CT Head Rule and PECARN pediatric rules guide imaging decisions. Symptoms are tracked daily with the SCAT6 or Post-Concussion Symptom Scale. Vestibular and oculomotor screening (VOMS), reaction time, and balance plate testing identify deficits and guide rehabilitation. Neuropsychological testing is added at the discretion of the team, especially for prolonged recovery or pre-existing baseline data. Blood biomarkers (S100B, GFAP, UCH-L1, and combined panels such as the Banyan Brain Trauma Indicator) are emerging tools that may help triage need for CT in adults but are not routinely used for concussion management in sport. The diagnostic process continues throughout the graduated return-to-play stages: any return of symptoms with cognitive or physical exertion requires a step back, and final medical clearance is required from a clinician trained in concussion management.
Key tests
01
Sport Concussion Assessment Tool 6th edition (SCAT6) — on-field and officeStandardized clinical evaluation including symptom checklist, orientation, immediate and delayed memory, concentration, neurological screen, balance, and tandem gait
02
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Treatment & cost
medical treatments
✓Structured return-to-play (6-stage) and return-to-learn protocols
✓Sub-symptom-threshold aerobic exercise (Buffalo Concussion Treadmill Test guidance)
✓Vestibular and oculomotor rehabilitation
✓Cervical physical therapy
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Causes & risk factors
known causes
Direct head impact in collision sports
Helmet-to-helmet or head-to-ground contact in football, rugby, and ice hockey; head-to-elbow contact in basketball and soccer. Most common mechanism in male contact sport. Linear and rotational accelerations transmitted to the brain produce diffuse axonal stretch and neurometabolic cascade.
Body impact with impulsive head movement
Tackles, body checks, and falls transmit force through the cervical spine to the brain without direct head contact. Whiplash-type rotational acceleration is a frequent mechanism in soccer, rugby, and lacrosse and produces concussion as severe as direct head impact.
Fall and ground contact
Falls from a horse, bicycle, or skiing or snowboarding crash transmit acceleration through the head and neck. In youth sport, ground contact during play is a leading mechanism, especially in soccer and basketball where direct impact between players is less common.
Cumulative head impact exposure
Repeated sub-clinical impacts in contact sports (heading in soccer, line play in American football, sparring in boxing) produce subconcussive changes. The cumulative load is linked to longer recovery from a subsequent concussion, neuropsychological changes during play, and post-mortem CTE in some athletes.
Inadequate or improper protective equipment
Old helmets, poorly fitting mouthguards, and absent neck strengthening contribute. While helmets reduce skull fractures and severe brain injury, they do not eliminate concussion and may not reliably reduce its incidence in current designs.
risk factors
Participation in contact and collision sportsmodifiable
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Living with it
01Enforce rules against helmet-to-helmet contact, head-first tackling, and high tackles; teach tackling and heading technique through certified coaching programs.
03Strengthen the neck musculature in contact-sport athletes, which is associated with reduced head-impact magnitudes.
04Limit youth-soccer heading exposure as per US Soccer (no heading under age 10; limited heading practice age 11-13).
05Educate athletes, coaches, parents, and officials on concussion recognition, mandatory removal from play, and reporting culture.
06Implement state-level Lystedt-style legislation requiring removal from play, written medical clearance, and concussion education for return to youth sport (now law in all 50 US states).
recommended foods
•Adequate hydration (≥2 L/day) during recovery and graduated return to exercise
•Balanced meals with carbohydrates, lean protein, and healthy fats; do not skip meals
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When to seek help
why see a sports medicine
Sport-medicine physicians, neurologists, neuropsychologists, and athletic trainers experienced in concussion management are essential for accurate diagnosis, individualized treatment, and safe return to play. Specialist involvement is particularly important for adolescent athletes, persistent symptoms beyond 2-4 weeks, recurrent concussions, and pre-existing migraine, anxiety, depression, ADHD, or learning disorder.
01Persistent post-concussion symptoms lasting beyond expected recovery (10-30% of cases) — manage with multidisciplinary rehabilitation.
02Second impact syndrome — rare, catastrophic cerebral edema in adolescents and young adults who return to play before complete recovery and sustain a second impact.
03Cumulative effects of recurrent concussions and subconcussive head impacts, with possible long-term neuropsychological consequences and risk of chronic traumatic encephalopathy in retired athletes with high exposure.
04Vestibular and oculomotor dysfunction causing chronic dizziness, balance impairment, and visual symptoms — responsive to targeted rehabilitation.
05Persistent post-traumatic headache, including migraine-pattern and cervicogenic headache.
Sport-related concussion (acute)Clinical injury occurring during sport or exercise with one or more of the recognized symptoms (somatic, cognitive, emotional, sleep) and physical signs after a head, neck, or body impact transmitting force to the brain. Most cases resolve within 14 days in adults and 4 weeks in adolescents with appropriate management.
Persistent post-concussion symptoms (≥4 weeks adolescents, ≥2 weeks adults)Symptoms lasting longer than expected recovery time. Occurs in 10-30% of cases and is more common in adolescents, females, those with pre-existing migraine, anxiety, depression, ADHD, learning disorder, or prior concussion. Requires multidisciplinary rehabilitation.
Second impact syndromeCatastrophic and often fatal cerebral edema after a second head impact occurring before complete resolution of an initial concussion. Almost exclusively reported in adolescents and young adults. Rare but a cornerstone reason for removal-from-play and graduated return-to-play protocols.
Subconcussive head impact exposureRepetitive head impacts that do not produce clinical concussion symptoms. Cumulative exposure in contact sports (football, soccer heading, boxing, rugby) is linked in some studies to later neuropsychological changes and to chronic traumatic encephalopathy in autopsy series.
Chronic traumatic encephalopathy (CTE)Progressive neurodegenerative tauopathy described in athletes with extensive head-impact exposure (especially American football, boxing, rugby, and ice hockey) and in military service members. Currently diagnosable only post-mortem. Clinical correlates (traumatic encephalopathy syndrome) are under active research.
Living with Concussion in Sports
Timeline
Most adults recover within 10-14 days; most adolescents within 4 weeks. Sub-threshold exercise typically begins at 24-48 hours; return to school in 1-2 weeks with accommodations; full academic load within 2-4 weeks; return to non-contact training at 1-2 weeks; full contact and competition typically 2-4 weeks after symptom resolution. Persistent symptoms (>4 weeks adolescents, >2 weeks adults) require multidisciplinary rehabilitation.
Lifestyle
01Disclose every suspected concussion to the medical team — concealed injuries lead to prolonged recovery and risk of catastrophic second impact.
02Follow the 24-48 hour relative rest period, then begin sub-symptom-threshold aerobic activity rather than prolonged cocoon therapy.
03Adhere to the graduated return-to-play and return-to-learn protocols, stepping back if symptoms return.
04Maintain a consistent sleep-wake schedule and aim for 8-10 hours of sleep nightly during recovery.
05Limit screen time during the symptomatic phase, especially in the first 48 hours and as a step before fully returning to academic work.
06Avoid alcohol, recreational drugs, and unnecessary sedating medications during recovery.
Daily management
01Track symptoms daily using the SCAT6 symptom checklist or a similar tool; share with the medical team at each follow-up.
Complementary approaches
Active rehabilitation programs (multidisciplinary)Combined vestibular, cervical, cardiovascular, and cognitive rehabilitation delivered in specialty concussion clinics. Evidence supports use in athletes with persistent symptoms (≥4 weeks) and complex presentations.
Sleep optimization and sleep hygieneRegular sleep-wake schedule, avoidance of screens and caffeine in the evening, and screening for and treatment of sleep apnea. Sleep is a critical recovery factor in concussion.
Mindfulness-based stress reduction and pacingUseful for athletes with anxiety, mood, and sleep symptoms during prolonged recovery; reduces somatic symptom amplification and improves return to function.
Choosing a doctor
Choose a sport-medicine physician, neurologist, or athletic trainer with explicit training and certification in concussion (CAQ in sports medicine, board certification in sport neurology, ImPACT credentialing). For adolescents, prefer a clinician integrated with the school's return-to-learn process. For prolonged symptoms, choose a multidisciplinary concussion clinic with vestibular therapy, neuropsychology, and behavioral health on site.
A sport-related concussion is a traumatic brain injury caused by biomechanical forces from a head, neck, or body impact during sport or exercise. It produces transient neurological symptoms (headache, dizziness, cognitive slowing, balance and vision problems) without structural injury seen on standard CT or MRI.
Do you have to lose consciousness to have a concussion?▾▴
No. Loss of consciousness occurs in only 10-15% of sport concussions. Concussion is diagnosed clinically based on symptoms after a head, neck, or body impact, including headache, dizziness, confusion, memory disturbance, balance problems, and emotional changes, with or without loss of consciousness.
What are the first signs of a concussion?▾▴
Common first signs include feeling dazed or 'shaken up' after impact, brief confusion, slowed responses, headache, dizziness, balance problems, nausea, sensitivity to light or noise, and memory disturbance. An athlete who looks 'not right' after a hit should be removed from play and assessed.
How is sport-related concussion diagnosed?▾▴
Diagnosis is clinical, made on the sideline and in the clinic using the Sport Concussion Assessment Tool 6 (SCAT6), which includes a symptom checklist, cognitive testing, neurological screen, and balance testing. CT or MRI is reserved for athletes with focal deficits, prolonged loss of consciousness, or other red flags.
When should an athlete return to play after a concussion?▾▴
Only after completing a graduated 6-stage return-to-sport protocol with each stage at least 24 hours and no return of symptoms, and with written medical clearance from a clinician trained in concussion. Returning to play before recovery raises the risk of prolonged symptoms and rare catastrophic second-impact syndrome.
How long does it take to recover from a sport concussion?▾▴
Most adults recover within 10-14 days and most adolescents within 4 weeks when modern protocols are followed. Persistent symptoms beyond these timeframes occur in 10-30% and warrant multidisciplinary rehabilitation. Pre-existing migraine, anxiety, depression, or ADHD lengthens recovery.
Should athletes rest in a dark room after a concussion?▾▴
No. The older 'cocoon therapy' of prolonged complete rest is no longer recommended and is associated with worse outcomes. Current consensus advises 24-48 hours of relative rest followed by sub-symptom-threshold aerobic exercise, normal sleep, and graduated return to learn and play.
Why is light aerobic exercise recommended after concussion?▾▴
Randomized trials in adolescents show that sub-symptom-threshold aerobic exercise starting 24-48 hours after injury shortens recovery from a median of 17 to 13 days. It improves autonomic regulation, mood, and sleep without worsening symptoms when titrated below the symptom-exacerbation heart rate.
Can concussion happen without a direct blow to the head?▾▴
Yes. Concussion is caused by impulsive force transmitted to the brain. Body impacts that produce rapid head acceleration (whiplash) can cause concussion even without direct head contact, especially in soccer, rugby, lacrosse, and ice hockey collisions.
Are helmets effective in preventing concussion?▾▴
Helmets reduce skull fractures, scalp lacerations, and severe traumatic brain injury but do not eliminate concussion. Modern helmets reduce linear impact but have less impact on rotational acceleration, which is a key concussion mechanism. Properly fitted, current-standard helmets remain essential for contact sports.
What is second-impact syndrome?▾▴
Second-impact syndrome is a rare, often fatal cerebral edema occurring when an athlete sustains a second head impact before recovery from a first concussion. It is almost exclusively reported in adolescents and young adults and is the cornerstone reason for strict removal-from-play and graduated return-to-play protocols.
What is chronic traumatic encephalopathy (CTE)?▾▴
CTE is a progressive neurodegenerative tauopathy described in autopsy series of athletes with prolonged head-impact exposure (especially American football, boxing, rugby, ice hockey) and in military service members. It is currently diagnosed only post-mortem. Clinical syndromes during life are being defined under the term traumatic encephalopathy syndrome.
Are female athletes at higher risk of concussion?▾▴
Yes, in equivalent sports. Female athletes have 1.5-2× higher concussion rates than males in soccer, basketball, and lacrosse, and many studies show longer recovery times. Hypothesized contributions include neck strength, hormonal cycle, biomechanics, and reporting culture; rates also vary by sport and position.
Can children continue school after a concussion?▾▴
Yes, with academic accommodations during the symptomatic phase. Return-to-learn typically precedes return-to-play and includes reduced workload, breaks, extended test time, and limited screen exposure. Most students return to full academic load within 1-2 weeks, with full sport return after 2-4 weeks.
What medications help with concussion symptoms?▾▴
Targeted symptomatic medications include amitriptyline or topiramate for persistent post-traumatic headache, melatonin for sleep disturbance, and SSRIs for persistent mood symptoms. Avoid opioids, benzodiazepines, and other sedating drugs. No medication is established to accelerate underlying recovery.
Should a CT scan be done after every concussion?▾▴
No. CT is reserved for athletes with focal deficits, prolonged loss of consciousness, repeated vomiting, severe or worsening headache, suspected skull fracture, anticoagulation use, or other red flags using clinical decision rules. Most sport concussions have normal imaging and do not require CT.
Can repeated concussions cause permanent damage?▾▴
Repeated concussions are associated with longer recovery from each episode and may carry long-term neuropsychological consequences in some athletes. Retired athletes with high cumulative head-impact exposure have shown chronic traumatic encephalopathy in autopsy series. The risk relationship for individual athletes during life is being defined.
What is the SCAT6?▾▴
The Sport Concussion Assessment Tool 6th edition is the standardized clinical assessment from the 2023 Amsterdam Consensus. It includes a symptom checklist, orientation, immediate and delayed memory, concentration, neurological screen, balance (modified BESS), and tandem gait. Child SCAT6 is the pediatric version.
Is loss of memory after a hit always a concussion?▾▴
Memory disturbance (retrograde or anterograde amnesia) immediately after a head impact is highly suggestive of concussion and warrants removal from play. Other causes of acute memory disturbance, including seizure and intracranial hemorrhage, must be considered if symptoms are atypical or progressive.
Do youth soccer players need to stop heading the ball?▾▴
US Soccer policy prohibits heading in players under age 10 and limits heading practice in ages 11-13 to reduce cumulative subconcussive exposure. Older youth and adult players can head the ball but should learn proper technique. Several European federations have introduced similar age-based limits.
Who is qualified to diagnose and clear an athlete after concussion?▾▴
A physician trained in concussion management — typically a sports medicine physician, neurologist, primary care sports medicine physician, or neurosurgeon — is qualified. Athletic trainers and team physicians assess and remove athletes from play; final return-to-sport clearance is made by a trained clinician per the 2023 Amsterdam Consensus.
•Suspected neck injury, with neck pain, paresthesia, or weakness
•Skull deformity, scalp laceration with bone visible, or fluid leaking from nose or ear
Maddocks orientation questions and brief neurological examRapid sideline screen for cognitive impairment immediately after impact
03
Vestibular/Ocular Motor Screening (VOMS)Identifies vestibular and oculomotor deficits driving headaches, dizziness, and visual symptoms
04
Balance Error Scoring System (modified BESS) and tandem gaitDetects balance deficits common in concussion that may persist after symptom resolution
05
Neuropsychological testing (paper-and-pencil or computerized: ImPACT, CogState, Axon Sports)Quantifies cognitive function relative to baseline or normative data; used for prolonged recovery and return-to-play decisions
06
Head CT (selected cases)Excludes skull fracture, intracranial hemorrhage, or other structural injury in athletes meeting clinical decision-rule criteria
07
MRI brain (selected cases)Used in prolonged or atypical recovery to exclude contusion, hemorrhage, diffuse axonal injury, or other structural cause; not routinely required in straightforward concussion
08
Blood biomarkers (GFAP, UCH-L1, S100B) — emergingTriages adults for CT imaging after mild TBI and may identify subclinical injury
Outlook
Most adult athletes recover within 10-14 days and most adolescents within 4 weeks when modern protocols (early sub-threshold exercise, graduated return-to-play, targeted rehabilitation) are followed. Persistent post-concussion symptoms beyond expected recovery time occur in 10-30% and are more common in adolescents, female athletes, those with prior concussions, and those with pre-existing migraine, mood, attention, or sleep disorders. Multidisciplinary rehabilitation resolves persistent symptoms in 70-90% of cases within 3-6 months. Recurrent concussions are associated with longer recovery from each episode and may be linked to neuropsychological changes; the impact of cumulative subconcussive head impact exposure remains under active investigation. Catastrophic outcomes (second-impact syndrome, intracranial hemorrhage) are rare when removal-from-play protocols are followed. Long-term outcomes of repetitive head impact exposure in contact sport, including chronic traumatic encephalopathy, have been documented in autopsy series of older athletes, though the relationship to clinical syndromes during life is being defined. Adherence to current consensus protocols, early recognition, and individualized return-to-play decisions are the most important modifiable factors.
American football, ice hockey, rugby, lacrosse, wrestling, and women's soccer carry the highest rates per 1,000 athlete exposures. Concussion incidence per game is 5-10× higher than per practice in most contact sports.
Prior concussionnon-modifiable
History of one or more prior concussions roughly doubles the risk of a subsequent concussion and lengthens recovery from each new injury.
Female sexnon-modifiable
In equivalent sports (soccer, basketball, lacrosse), female athletes have 1.5-2× higher concussion rates than males and longer recovery times in many but not all studies. Hypothesized contributions include neck strength, hormonal cycle, reporting culture.
Age 12-19 yearsnon-modifiable
Adolescents have longer recovery than adults due to ongoing neurodevelopment and higher rates of comorbid migraine and anxiety. They are also at higher risk for second-impact syndrome.
Pre-existing migraine, anxiety, depression, ADHD, learning disorder, or sleep disordermodifiable
Each condition is independently associated with longer recovery and higher risk of persistent post-concussion symptoms. Pre-injury baseline testing is recommended to distinguish new symptoms from pre-existing ones.
Inadequate concussion reporting culturemodifiable
Athletes who underreport symptoms continue to play and are at risk for prolonged recovery and second impact. Modifiable through coach, parent, and athlete education and through formal reporting protocols.
Specific player positions and game situationsmodifiable
Defensive linemen, linebackers, and special-teams players in football; defenders in soccer; and goaltenders in lacrosse are positions with elevated rates. Heading drills in youth soccer (now restricted in many leagues) contribute to subconcussive exposure.
•Omega-3-rich foods (fatty fish, walnuts, flax) — modest neuroinflammatory evidence in animal studies and limited human data
•Antioxidant-rich foods (berries, leafy greens, citrus) as part of an overall healthy diet
foods to avoid
•Alcohol during the symptomatic phase and within the first 1-2 weeks of injury
•Stimulant beverages (energy drinks, high caffeine) that worsen sleep disturbance
•Skipping meals, which exacerbates fatigue, headache, and mood symptoms
•Unproven dietary supplements marketed for concussion recovery without medical supervision
06
Mood disorders, sleep disorders, and academic or vocational decline during prolonged recovery — addressed through CBT, sleep optimization, and academic accommodations.
choosing the right hospital
01Sport-medicine clinic with concussion-trained physicians and athletic trainers
02Vestibular and oculomotor rehabilitation program
03Access to neuropsychological assessment
04Integration with school return-to-learn process for adolescents
05Multidisciplinary concussion clinic for prolonged cases
Essential facilities
University and professional team sport-medicine departmentsConcussion clinics with multidisciplinary carePediatric sports medicine programsVestibular rehabilitation centersEmergency departments with TBI protocols
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02Maintain consistent sleep, hydration, and meal timing.
03Limit cognitive load (screens, reading, schoolwork) during the symptomatic phase, then progressively reintroduce.
04Perform sub-threshold aerobic exercise daily once medically advised.
05Notify the medical team of any new or worsening symptoms, particularly severe headache, repeated vomiting, increasing confusion, or focal deficit.
06Do not return to contact or high-risk activity without written medical clearance.
Exercise
After 24-48 hours of relative rest, begin sub-symptom-threshold light aerobic exercise (walking, stationary cycling) for 20-30 minutes daily at a heart rate that does not provoke significant symptom exacerbation. Progress through the 6-stage return-to-sport protocol with at least 24 hours between stages; do not advance if symptoms return. Avoid contact and high-fall-risk activities until medical clearance has been granted.