Concussions in Queens Student Athletes

Every fall in Queens, thousands of student athletes take the field for football, soccer, cross country, and volleyball. Every spring, there are baseball, softball, lacrosse, and track seasons. Year-round, there are basketball courts, wrestling mats, and swimming pools. And throughout all of it, concussions happen.

What most parents, athletes, and even some coaches do not fully understand is that in New York State, returning to play after a suspected concussion is not a judgment call. It is a legal process with specific steps that must be followed before a student athlete is permitted back on the field or court.

Getting that process wrong does not just risk the athlete's health. It exposes schools, coaches, and parents to liability and, more importantly, puts a young athlete at risk of Second Impact Syndrome, a rare but potentially catastrophic consequence of returning to play before the brain has healed.

This guide explains what New York State law requires, what the graduated return-to-play protocol looks like in practice, what role a physician plays in the clearance process, and how families in Queens can access that clearance without navigating a hospital referral system.

What New York State Law Actually Requires

The New York State Concussion Management and Awareness Act, codified in Education Law Section 305-a, establishes legally binding requirements for how schools must manage suspected concussions in student athletes. Every school district in New York State is required to comply.

The law requires three things.

First: Any student athlete who is suspected of sustaining a concussion during practice or competition must be removed from play immediately. The standard is suspicion, not confirmation. A student does not need to be officially diagnosed with a concussion to be removed. If a coach, parent, athletic trainer, or official suspects a concussion, the student comes off the field. No exceptions.

Second: The student may not return to play on the same day the suspected concussion occurred. This is an absolute rule under New York State law. No physician, coach, or parent can authorize same-day return to play following a suspected concussion in a student athlete.

Third: Before the student may return to any athletic activity, they must be evaluated by and receive written clearance from a licensed physician. In New York, only a licensed physician (MD or DO) can provide the written clearance required by law. A physical therapist, chiropractor, athletic trainer, or nurse practitioner is not authorized under New York State Education Law Section 305-a to provide return-to-play clearance for student athletes.

Recognizing a Concussion

A concussion is a traumatic brain injury caused by a biomechanical force to the head or body that causes the brain to move within the skull. It does not require a direct blow to the head. A collision, a fall, or a jarring impact to the body can transmit enough force to cause a concussion. Loss of consciousness is not required and occurs in fewer than 10 percent of concussions.

Symptoms fall into four categories:

Physical Symptoms

Headache, pressure in the head, nausea, vomiting, dizziness, balance problems, blurred or double vision, sensitivity to light, sensitivity to noise, and fatigue. Headache is the most common symptom, present in over 70 percent of concussions.

Cognitive Symptoms

Feeling slowed down, feeling foggy or in a daze, difficulty concentrating, difficulty remembering, and confusion about what happened during the injury.

Emotional Symptoms

Increased irritability, sadness, nervousness, and emotional lability, meaning crying or becoming upset more easily than usual.

Sleep Symptoms

Sleeping more than usual, difficulty falling asleep, and sleeping less than usual.

Symptoms may appear immediately at the time of injury or may be delayed by hours, which is why continued observation of an athlete after a suspected head impact is important even if they initially appear fine.

When to Go to the Emergency Room

Most concussions do not require emergency room evaluation. However, certain symptoms following a head injury indicate a more serious intracranial injury that requires immediate emergency care.

These symptoms suggest a bleed or structural injury inside the skull that requires CT imaging and neurosurgical evaluation, not a standard concussion protocol.

For the vast majority of student athlete concussions without these red flags, evaluation at our Astoria walk-in orthopedic clinic is appropriate and is sufficient for New York State clearance purposes.

The Six-Step Graduated Return-to-Play Protocol

New York State and national sports medicine organizations require that student athletes follow a graduated return-to-play protocol before resuming full athletic activity. The protocol has six steps. Each step must take a minimum of 24 hours. The athlete must be completely symptom-free before beginning Step 1. If symptoms return at any step, the athlete drops back to the previous step after another 24 hours of symptom-free rest.

The entire protocol takes a minimum of 5 days following complete symptom resolution. Most student athletes with uncomplicated concussions complete the protocol within 7 to 14 days of injury. Athletes with a history of prior concussions may require longer recovery times and closer medical supervision.

Second Impact Syndrome

Second Impact Syndrome occurs when an athlete who has not fully recovered from a concussion sustains a second head impact before the brain has healed. The result can be rapid, catastrophic cerebral edema, meaning dangerous swelling of the brain, that can cause permanent neurological injury or death.

Second Impact Syndrome is rare, but it disproportionately affects adolescent athletes, whose brains are more vulnerable to cumulative concussive injury than adult brains. The entire purpose of the New York State graduated return-to-play law is to prevent this outcome.

This is why the physician clearance step exists. It is not administrative paperwork. It is a clinical checkpoint designed to ensure that no athlete returns to contact sport while they are still in a vulnerable neurological state.

What the Physician Clearance Letter Must Include

To satisfy New York State requirements, the written return-to-play clearance from a physician must:

• Confirm that the student athlete has been evaluated following a suspected or confirmed concussion
• Confirm that the athlete is currently asymptomatic
• Confirm that the physician has reviewed the athlete's progress through the graduated return-to-play protocol
• State that in the physician's clinical judgment the athlete is cleared to return to full-contact athletic activity
• Be signed by a licensed physician (MD or DO) and identify the date of evaluation and athlete's name

Most school athletic departments have a standard acceptance letter template, but a physician-written letter on clinic letterhead is typically accepted. If your school has a specific form, bring it to your appointment and we will complete it at the same visit.

Common Mistakes That Delay Return to Play

Waiting for a Specialist When You Do Not Need One

The most common mistake families make is waiting to see a neurologist when the law only requires a licensed physician. Some parents spend weeks trying to get a neurology appointment when a walk-in orthopedic physician evaluation at our Astoria clinic is what the law actually requires and is fully sufficient for clearance.

Returning the Athlete to Practice Before Step 5

Even if the athlete feels completely fine, New York State law requires physician clearance before Step 5. An athlete who returns to contact practice without clearance, and then sustains a second injury, creates significant liability for the school and potentially for the parents.

Rushing Through the Early Steps

Each step requires a minimum of 24 hours. Some athletes and families, feeling time pressure from a critical game or tournament, try to compress the protocol. Symptom recurrence at Step 2 or 3 is a sign the brain is not ready, and pushing through it risks extending recovery time significantly.

What to Expect at Our Astoria Clinic

We evaluate student athlete concussions at our walk-in orthopedic clinic at 3274 Steinway Street, Astoria NY.

Initial Evaluation

No appointment required. Walk in during open hours and let the front desk know you are there for a concussion evaluation and return-to-play clearance. Bring any documentation from the school or athletic department regarding the injury, including any injury report or concussion notification form.

The Physician Assessment

The physician will take a history of the injury, review symptom progression since the injury, perform a neurological and balance assessment, and assess cognitive symptoms. If the athlete is still symptomatic, the physician will advise on the appropriate stage of the return-to-play protocol and schedule a follow-up evaluation for clearance.

Return-to-Play Clearance

If the athlete is asymptomatic and has completed the graduated protocol steps, the physician will evaluate readiness for return to full contact and, if appropriate, provide written clearance. If you bring a school form, we complete it at the visit. We also provide a written concussion management plan for athletes with a history of multiple concussions, which can be shared with the school athletic department.

Open Monday to Friday 9 AM to 6 PM, Saturday 1 PM to 9 PM, and Sunday 9 AM to 5 PM. Call (347) 354-1328 or book online.

Frequently Asked Questions

The Bottom Line

Concussion management for Queens student athletes is not optional, and it is not informal. New York State law specifies exactly what must happen before a student athlete returns to contact sport, and a licensed physician is a required part of that process.

The good news is that the process does not have to be complicated or slow. Most athletes with uncomplicated concussions can be evaluated, supported through the graduated protocol, and cleared within two to three weeks of injury. What matters is starting the process correctly, following the steps in order, and not skipping the physician clearance that the law requires.

If your student athlete has sustained a concussion, or if you are a coach or athletic director who needs reliable physician support for your athletes, our orthopedic clinic in Astoria is here for that. Walk in, no referral needed, seven days a week.

Call (347) 354-1328 or book online. 3274 Steinway Street, Astoria NY 11103. Open 7 days a week.