TrueSport: Top Medical Reasons for Returning to Sport After COVID-19

There has been a lot of focus on protecting young athletes’ physical and mental wellbeing during the COVID-19 pandemic, but despite all the precautions, not everyone has been fortunate enough to avoid infection. And unfortunately, after recovering from COVID-19, people are at higher risk of myocarditis—inflammation of the heart often caused by a viral infection—and even asymptomatic, healthy young athletes are at risk.

“COVID-19 has an affinity for heart tissue,” explains Dr. Michele LaBotz, TrueSport Expert and sports medicine physician. There have been reports of professional and collegiate athletes, as well as children, suffering from myocarditis after recovering from COVID-19. “Even before COVID-19, myocarditis was one of the biggest causes of sudden cardiac death in athletes. We’ve always known about it, but it’s newly prominent,” LaBotz adds.

Myocarditis after COVID-19 isn’t a death sentence and it usually resolves after an appropriate recovery period. But it’s important to know the symptoms of myocarditis and to return to sport the right way based on the severity of a young athlete’s symptoms and intensity of the sport. LaBotz also notes that the guidelines for students with COVID-19 are changing all the time, so if your athlete does test positive for the virus, it’s important to contact their physician to get the current return-to-play recommendations.

Recognize the Symptoms of Myocarditis

Have your athlete be on the lookout for warning signs, like a sudden increase in perceived exertion (if an exercise that was easy before is suddenly feeling difficult), undue fatigue, chest pain, and shortness of breath. If your athlete starts to exhibit any of these symptoms, contact your primary care provider immediately. Typically, a doctor will run an EKG and possibly some additional labs looking for damage to heart tissue. Your child may need to see a cardiologist for a follow up, and if diagnosed with myocarditis, expect your athlete to need between three and six months of rest to recover completely.

Account for Symptom Severity and Sport Intensity

All athletes who have had documented COVID-19 infections should ideally contact their primary care physician before returning to practice or high intensity physical activity. Although myocarditis can develop in any athlete infected with COVID-19, it is more likely to occur in patients who had more severe or prolonged COVID-related symptoms.

Asymptomatic COVID-19 Infections

“If you have a child who has no symptoms but has had a positive test, they should not do any intense physical activity for 14 days,” says LaBotz. “As long as they don’t have any symptoms emerge and as long as they’re otherwise healthy, then they can gradually ramp up their activity over a period of about 5-7 days.” That means starting with low-intensity exercise like walking, and slowly progressing for a week before returning to full practice.

If your child has been exposed to someone with COVID-19, current recommendations are for two weeks away from practice regardless of test results. This is key to both slowing the spread of COVID-19 through a team, and ensuring that your athlete isn’t training through an asymptomatic bout of the virus.

Mild Symptoms

Mild symptoms include runny nose, slight cough, mild fever—typical ‘cold-like’ symptoms, LaBotz explains. In cases where an athlete experiences any COVID-19 symptoms, the two weeks of rest start after your child no longer has any signs or symptoms of the virus. “As long as your child remains asymptomatic, then they can gradually build up their activity, again, starting with low intensity and progressing over the course of several days,” LaBotz adds. “And while they are building up activity levels, if they develop any symptoms of myocarditis or COVID-19, they should stop immediately and talk to a doctor.”

Particularly if your athlete is returning to a high-intensity sport, LaBotz recommends contacting the athlete’s primary care physician to get cleared for play. “If your athlete is in a high-intensity sport, has a family history of cardiac issues, or even has anxiety around return to play, your primary care doctor may want to perform an EKG before returning to sport,” she says.

Moderate Symptoms

If symptoms are slightly worse—higher fever, bad cough—but hospitalization isn’t required, current recommendations are that an athlete get an EKG before returning to play. However, depending upon the athlete’s previous history, some health care providers may require additional testing before athletes can be cleared to play. After symptoms subside, athletes then need two weeks of rest. If they remain asymptomatic during this time, then athletes can gradually return to sport as described above.

Severe Symptoms

If your athlete is hospitalized with severe symptoms of COVID-19 or has been diagnosed with Multi-System Inflammation Syndrome in Children (MIS-C), they should be treated as though they have myocarditis and only return to sport after being cleared by a cardiologist.

“There will be a lengthy recovery period and your athlete will need multiple tests to return to play,” LaBotz adds. “It typically takes 3-6 months for recovery. You just have to let the heart heal, because if you don’t, scar tissue develops and that means permanent damage to a really important muscle.”

Beware of a Fast Return in General

“This fall we’re seeing an increase in the severity of some of the injuries we typically see in high school athletes,” LaBotz adds. “Some athletes went from not doing much to suddenly jumping right into the full season without the usual preseason work. I’ve also seen a few kids injured because they were training a lot over the summer since there wasn’t much else going on, and now they have stress fractures and other overuse injuries. The same thing can happen if an athlete has to take a few weeks off to recover from COVID-19, so that slow return is extremely important.”

Takeaway

As more young athletes return to school and sport, it’s important to understand that past COVID-19 infections, and even undiagnosed or asymptomatic infections, can impact an athlete’s health and their heart health in particular. Learn to recognize the symptoms of heart issues and moderate your athlete’s return to play based on symptom severity and intensity of sport. Additionally, if you have an athlete who has a compromised immune system due to their disability, be aware of their limitations and confirm with their parents prior to engaging them back into activities.

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