Returning to Sports After a COVID-19 Infection
If your teen athlete has been sidelined by COVID-19, you might have concerns about her physical and mental readiness as she prepares to get back in the game. Keep the following questions and guidelines in mind when considering whether she's ready to return to sports.
Your teen may appear to be fully recovered from COVID-19, and is probably very eager to return to the activities she loves. But before you allow her to get back into the gym or out on the field, there are some precautions you should take to ensure she’s physically and mentally ready to return to sports.
Why? We now know this virus can be linked to health problems that may last well beyond the initial wave of symptoms. Kids may also experience depression or anxiety when they’re out of the game for an extended period of time, and their bodies may be deconditioned, putting them at greater risk for injury.
“These all tend to get worse the longer an athlete is out of a sport, but they could happen even over a relatively short isolation or quarantine period,” says Children's Healthcare of Atlanta pediatric sports medicine physician Armand Scurfield, MD.
This is why it’s so important to be sure you’re up to speed on the most recent return-to-sport recommendations for teen athletes who have tested positive for COVID-19.
Priority number one after your child tests positive for COVID-19 is to be sure she isolates for the appropriate amount of time. This will not only help prevent the spread of the virus, but it will also give your teen time to fully recover from the illness. For guidance, see the latest isolation guidelines from the U.S. Centers for Disease Control and Prevention (CDC).
Next steps after isolation
Once the isolation period is up and symptoms have subsided, your teen can slowly reintroduce light physical activity into her routine. How quickly this can happen depends on the severity of the illness. Here are some general guidelines to help you determine how soon your athlete can be up and running:
- Asymptomatic or mild symptoms (fewer than four days of fever and less than one week of body aches, chills, fatigue)
- The athlete should be at least five days from a positive test and fever-free for at least 24 hours without the use of fever- or symptom-reducing medications before she gradually returns to sports.
- Monitor for any signs of exercise intolerance, including shortness of breath, heart palpitations, chest pain with exercise, or fainting. Stop exercise and seek further evaluation if these occur.
- Moderate symptoms (four days or more of fever greater than 100.4°F or one week or longer of symptoms)
- The athlete needs to be at least 10 days out from a positive test or from symptom onset, fever-free and symptom-free for at least one day without the use of fever- or symptom-reducing medication. She also needs to be screened by her pediatrician with a physical exam and an ECG test for her heart prior to returning to sports.
- Severe symptoms (hospitalized for treatment)
- The athlete will be required to obtain clearance by her pediatrician and may need an evaluation by a cardiologist as well. Children who experience severe symptoms may have to wait three to six months before returning to athletic activities.
Masking period after isolation
Athletes 12 years old and up who are cleared to gradually return to sports should remain masked at all times when around other people until they are symptom free and it has been 10 days since symptoms began or 10 days since they received a positive test result.
Why is it important for teen athletes to see a doctor after a COVID-19 infection?
Before your teen is officially back on the roster and running in step with her teammates, she needs to be evaluated by a pediatrician or a primary care provider. Getting the all-clear by a physician is one easy step for safety and can give you peace of mind.
COVID-19 is a new illness, and our understanding of how it impacts the body is evolving the more we study it. We know that it’s rare for kids and teens to experience serious complications from the virus, but it does happen. And the last thing you want is for your child to go undiagnosed.
When your child visits a pediatrician, the doctor will assess readiness to return to sports, both mentally and physically.
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- Irritability or anger
- Feelings of worthlessness
- Decrease in energy and motivation
- Social withdrawal
"Parents and athletes should look out for these issues if they have been away from organized sport for any length of time due to COVID-19 concerns," says Dr. Scurfield.
If your teen experiences any new heart-related symptoms while sick with COVID-19, during her recovery period from the virus or when she returns to her regular activities, a checkup with a pediatric cardiologist is highly recommended. Concerning heart symptoms may include:
- Chest pain
- Shortness of breath
- Heart palpitations
“Fortunately, heart problems after COVID-19 are rare in children and adolescents,” says Matthew Oster, MD, MPH, Director of the Cardiac Outcomes Research Program at the Children’s Heart Center. “However, it is important to seek cardiac evaluation if a child has any concerning heart symptoms during their COVID-19 illness or after they return to play.”
During an exam with a cardiologist, your teen will share her medical history as well as her family medical history in case anyone has a heart condition. She may also undergo an electrocardiogram, or ECG, which measures the electrical signals that control the heart and can help doctors see if there is evidence of heart disease.
- If cardiac symptoms/screening are negative and the ECG is normal, the pediatrician could clear her to begin a gradual, four-day minimum progression back to sports
- If cardiac symptoms/screening are positive or the ECG test is abnormal, a referral to a cardiologist is recommended before returning to sports or activities.
“Based on the results of this initial exam, we may have to schedule additional tests like an echocardiogram, ambulatory rhythm monitoring, exercise test or cardiac MRI,” Dr. Oster says. “This will also give us a chance to figure out whether your teen athlete may need to be restricted from activities like sports practices and games for any specific amount of time.”
In most cases, as long as the athlete closely follows her physician’s recommendations and reaches out to her doctor if any concerning symptoms begin or continue, she should be able to return to sports gradually without worry, Dr. Oster adds.
If your teen athlete has had MIS-C, she will be restricted from all sports for about three to six months, or until she is cleared by a pediatric cardiologist.
“What we’ve learned through our research is that heart-related issues are common in children who are diagnosed with MIS-C, but these problems tend to resolve after a few weeks to months,” says Dr. Oster.
In addition to heart complications, kids with this condition also may experience inflammation throughout the body, shock or low blood pressure.
Your child may return to sports when their isolation or quarantine is completed and they are fully recovered, but doctors advise that she do so gradually to limit her risk for injury. When an athlete is away from sports or activities for any extended amount of time—from a couple of weeks to a month or longer—her body isn’t prepared to just jump right back into activity.
“An athlete’s bones, tendons, ligaments, muscles and organs, including the heart and lungs, undergo deconditioning, all of which put the athlete at high risk of injury if returning to sports too quickly,” says Dr. Scurfield. “Athletes are at high risk for stress fractures, ligament tears, muscle strains, and all kinds of injuries if they try to do too much too soon. Their bodies need to gradually build up to the physical demands of their sport.”
This is why Dr. Scurfield recommends athletes follow the American Academy of Pediatrics recommended guidelines for returning to sports after being quarantined or isolated due to COVID-19. “You don’t want to try to rush back into your sport too quickly just to get injured and have to sit out for another lengthy period of time,” he says.
Can my teen athlete compete as usual after she’s been cleared by her doctor?
After an athlete has been cleared by her doctor to return to play, it’s important to encourage her to still proceed with caution and listen to her body. It may take seven to 10 days to get back to her baseline activity level. If she had a more moderate or serious COVID-19 illness, this period may be longer. Encourage her to talk with her coach about the doctor’s recommendations for a gradual return to practices and competition, and to speak up if she is experiencing any symptoms or has any concerns.
“Talk to your teammates, parents, athletic trainers, coaches, pediatrician and/or a sports medicine physician if you have any concerns at all,” says Dr. Scurfield. “We all want you back playing sports and doing what you love. Just make sure that you gradually return to activities to help avoid serious injury.”
Armand Scurfield, MD, a Pediatric Sports Medicine Primary Care Physician, is board certified in pediatrics and sports medicine. His expertise lies in diagnosing and managing musculoskeletal injuries and concussions in growing athletes. He is a member of the American Academy of Pediatrics (AAP), the AAP Council on Sports Medicine and Fitness, the American Medical Society for Sports Medicine, and the Pediatric Research in Sports Medicine Society (PRiSM). He currently serves as the team physician for Kell High School.
Matthew Oster, MD, a Pediatric Cardiologist at Children’s Healthcare of Atlanta, is board certified in pediatric cardiology. Dr. Oster earned his Doctor of Medicine at University of Pennsylvania School of Medicine. He completed his residency at the University of California–San Francisco Medical Center, followed by a fellowship at Children’s and Emory University School of Medicine.
This content is general information and is not specific medical advice. Always consult with a doctor or healthcare provider if you have any questions or concerns about the health of a child. In case of an urgent concern or emergency, call 911 or go to the nearest emergency department right away. Some physicians and affiliated healthcare professionals on the Children’s Healthcare of Atlanta team are independent providers and are not our employees.