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.
Student athlete with a suspected concussion in Queens? We provide physician concussion evaluation and return-to-play clearance letters at our Astoria clinic. Walk-in for initial evaluation. Open 7 days a week. Call (347) 354-1328 or walk in to 3274 Steinway Street, Astoria NY.
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.
Only a licensed physician (MD or DO) can provide return-to-play clearance under NY State Education Law Section 305-a. A nurse practitioner, physical therapist, chiropractor, or athletic trainer cannot satisfy this requirement. Many families lose weeks waiting for a specialist appointment when a walk-in concussion evaluation at our Astoria clinic is all that is legally required.
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.
The athlete reports any symptoms listed above, appears dazed or stunned, seems to have slowed reactions or is confused about assignments, cannot recall events before or after contact, loses consciousness for any duration, or their behavior seems different than normal. When in doubt, sit them out.
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.
Loss of consciousness lasting more than a few seconds. Pupils that are unequal in size or unresponsive to light. Repeated vomiting. A seizure. Increasing or worsening headache not responding to over-the-counter pain medication. Weakness, numbness, or tingling in the arms or legs. Extreme drowsiness or inability to be woken. Slurred speech or difficulty recognizing people or places.
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.
| Step | Activity | Goal |
|---|---|---|
| Step 1 | Complete Rest | No physical or cognitive exertion. Continue until fully asymptomatic at rest. Typically 24 to 72 hours. |
| Step 2 | Light Aerobic Exercise | Walking, swimming, or stationary cycling at low intensity. No resistance training. No head-contact risk. |
| Step 3 | Sport-Specific Exercise | Running or skating drills. No head impact activities. Introduce sport-specific movement without contact. |
| Step 4 | Non-Contact Training Drills | Complex drills with passing, agility, coordination. Resistance training may begin. No contact. |
| Step 5 | Full-Contact Practice | Physician clearance required before this step. Written clearance per NY Education Law 305-a must be obtained first. |
| Step 6 | Return to Full Competition | Full participation in games and competitions resumes. |
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.
Following the New York State protocol protects both your athlete's brain and your family from liability. Schools, coaches, and parents who allow a student athlete to return to play without physician clearance face significant legal exposure if a second injury occurs.
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.
Walk in to our Astoria clinic for same-day concussion evaluation. No appointment needed for initial evaluation. If the athlete is asymptomatic and has completed the graduated protocol, we can provide clearance at the same visit. Bring the school form and we complete it on-site.
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.
Our clinic sees high volumes of concussion evaluations in August, September, March, and April corresponding to fall and spring sports seasons. If your athlete sustained a concussion recently and needs clearance, earlier evaluation is better. Do not wait for a primary care appointment if one is not available quickly.
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
No. New York State Education Law Section 305-a specifies that written clearance must come from a licensed physician, meaning an MD or DO. A nurse practitioner or physician assistant is not authorized under this law to provide return-to-play clearance for student athletes. Confirm with your school that the clearance you obtain meets their specific documentation requirements.
Most uncomplicated concussions resolve within 7 to 14 days in adolescent athletes. The graduated return-to-play protocol takes a minimum of 5 days following complete symptom resolution. Total time from injury to full return is typically 10 to 21 days for a first concussion with no complications. Athletes with prior concussions or prolonged symptoms may require longer.
A history of prior concussions is clinically relevant and should be disclosed to the evaluating physician. Athletes with multiple concussions may have a lower threshold for symptom recurrence and may require modified return-to-play timelines. There is no fixed number of concussions that automatically bars an athlete from participation, but the decision requires individual clinical evaluation.
Most concussions do not require brain imaging. CT and MRI are reserved for cases where there is clinical concern for a structural intracranial injury, such as bleeding or fracture. Your physician will assess whether imaging is indicated based on the symptom picture and examination findings.
Concussion symptoms lasting beyond 4 weeks are classified as persistent post-concussion syndrome. This requires a more comprehensive evaluation and may involve referral to a sports neurologist or concussion specialist. If your child's symptoms are not improving on a reasonable timeline, come in for re-evaluation rather than waiting.
Yes, in most cases. School attendance with appropriate academic accommodations, such as reduced screen time, shortened assignments, extended test time, and breaks in a quiet space, is generally preferable to complete absence. Your physician can provide a written academic accommodation recommendation for the school nurse and teachers if needed.
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.
For life-threatening emergencies, always call 911 or go to the nearest emergency room.
Medical Disclaimer. This article is provided for educational purposes only and does not constitute medical advice or legal advice. The information here cannot replace evaluation by a licensed medical professional or consultation with a licensed attorney. If you are experiencing a medical emergency, call 911 or go to the nearest emergency department. Treatment recommendations vary based on individual clinical findings.
Practice Information. Health Wellness Medical Astoria PLLC, 3274 Steinway Street, Astoria NY 11103. Phone: (347) 354-1328. Hours: Monday to Friday 9:00 AM to 6:00 PM, Saturday 1:00 PM to 9:00 PM, Sunday 9:00 AM to 5:00 PM.