Concussion 101: Return To Play
Welcome back to Concussion 101.
Today I am going to focus on getting back on the field following a concussion. If you have been reading along we have discussed concussions in regards to how they occur, what they are, healing and management. So today we are going to wrap up with return to play.
It is essential that we take concussions seriously from start to finish. If we return our athletes to play too soon, or they do not report the injury, there can be serious, often life threatening consequences.
So let’s get going.
My child has been diagnosed with a concussion, what’s next? When can she play her sport again?
This answer varies depending on who your medical provider is, as there are a range protocols that we may follow. However, the consensus is usually the same in these areas:
1. Your athlete must be symptom free
2. The athlete must have returned to baseline or better neurocognitive, psychological assessment if they had one administered (examples of this type of assessment are ImPact testing, Concussion Vital Signs, etc.)
3. CT scan must return to normal (if one was administered at diagnosis)
4. The patient must be symptom-free with exertion (running, weight lifting, hard physical work, etc.)
5. Clearance is given by a physician or certified athletic trainer (ATC), who practices under physician guidance
At Gwinnett Medical Center, the Sports Medicine program follows current best practices in concussion management, and the return-to-play process includes all of the above. In addition, our best-practices protocol was devised by our team of neurologists, neuropsychologists and ATCs who manage concussions every day at the Concussion Institute. It is based on the latest evidence about how to manage concussions. Athletes in our care do not go back to play until the are completely in the clear, including in the clear as regards recurring issues.
It’s important to remember that each time an athlete receives a concussion, they are more susceptible to concussions down the road. Concussion damage can accumulate over time. With each new concussion, it may take longer to recover and less of a blow to the head for an additional concussion to occur.
What happens if a concussed person continues to play?
Well folks, here’s where it gets scary.
Second impact syndrome is a serious injury that can occur when head trauma is left unchecked or the patient is returned to contact sports too soon.
With second impact syndrome, the unhealed brain is exposed to further trauma. This trauma, often times less intense than the original blow, can cause further damage and can be life threatening.
Coma and significant cognitive, psychomotor and psychological damage can occur. This is the reason we are so conservative in returning and clearing athletes for play when a concussion is suspected.
There is also a condition called post concussive syndrome (PCS), when symptoms of a concussion linger for long periods of time and affect daily life. With PCS, a person needs to seek the care of a neurologist to monitor symptoms and will not be cleared to play until symptoms are managed or ended.
Both of these issues are significant reasons to limit play and risk of contact. You only have one brain and need to care for it with diligence. At Gwinnett Medical Center we are committed to education, to ImPact testing to set baselines and clearance standards, to posting certified athletic trainers (ATC) in as many arenas as possible, and to limiting the impact of concussion-related outcomes as much as possible.
So, that wraps up Concussions 101. I am hopeful that this information was useful to you in some way.
Concussions are scary injuries, however, the more we know and understand, the better we can protect our kids and ourselves from brain injury. Should we pull our kids off the gridiron, the courts and the pitch? Absolutely not! The benefit far outweighs the risk.
But we do need to keep our kids safe. Education and prevention is the way to go.
As always, thanks for reading and stay healthy my friends!
For more info regarding concussions, see gwinnettmedicalcenter.org/concussion, or cdc.gov/concussions
Reference: Broglio, S. P., Cantu, R. C., Gioia, G. A., Guskiewicz, K. M., Kutcher, J., Palm, M., & McLeod, T. C. V. (2014). National Athletic Trainers' Association position statement: management of sport concussion. Journal of Athletic Training, 49(2), 245.