Symptomatic Minor and a Promoter's Request
Seventeen-year-old amateur, 3-0, took a hard right hand in sparring 10 days ago. He reports headache, nausea, and 'seeing stars' when he sprints, and he has not trained since. He is entered in a tournament in six days; his father says he has 'rested enough' and asks you to 'sign him off'. The promoter calls and asks you to confirm the kid is cleared, and the gym's insurance form requires a coach's signature. You are a certified conditioning coach, not a physician. The kid says he feels 'mostly fine' and is worried about losing his place in the tournament. He had one previous concussion two years ago and missed three weeks. His physics exam is in three days and he has been unable to study for two of them.
1. State your decision and the reasoning behind it, including your scope of practice.
Read the worked answer
Decision: he is not cleared, and you cannot clear him
- Headache, nausea and symptom provocation with sprinting 10 days after a concussive blow mean he is still symptomatic and, by definition, not ready for a graded return - let alone competition in six days.
- A previous concussion with three weeks lost increases susceptibility and should lower the threshold for caution.
- Concussion diagnosis and clearance are medical acts. As a conditioning coach you can observe, remove an athlete and refer, but you cannot diagnose or sign medical clearance. A coach's signature on an insurance form attests to your own supervision, not medical fitness.
- The promoter's request and the parent's reassurance do not change the risk. Second-impact syndrome and prolonged recovery are the downside.
Action: no training, no sparring, no competition. Refer to a physician experienced in concussion the same day, give written information to the parent, and document both the promoter's request and your refusal.
Line to hold: 'I can pull him from training. I cannot clear him - that is a doctor's job.'
2. Describe how you handle the father, the promoter, the return-to-sport pathway and your record-keeping.
Read the worked answer
Process
- Father: explain that the coach's role is removal and referral, not clearance, and that a doctor must guide return. Acknowledge the tournament matters to the family while being clear it cannot outweigh the risk.
- Return-to-sport pathway: only after symptoms resolve and with medical sign-off - light activity, then aerobic work, then strength, then non-contact skills, then contact. Each step 24 hours apart, stopped if symptoms return.
- Promoter: tell them in writing that the athlete is medically un-cleared and that you will not certify him; ask what the event's medical review process is.
- Sanctioning body: notify the medical officer. Most events accept only physician clearance.
- School: advise rest and academic accommodations for the physics exam rather than pushing through.
- Emergency escalation: vomiting, worsening headache, confusion, seizure, weakness or unequal pupils means emergency care, not a clinic appointment.
- Records: dated notes of symptoms, who said what, your referral, and the refusal. Keep the athlete's welfare above the tournament place.