Return to Play

Take time to heal

A concussion is a brain injury

Sometimes called the "invisible injury" all concussions should be treated seriously, even those that don't require a trip to the hospital.  Although diagnostic tests such as CAT scans or MRIs are typically negative, it does not mean an injury did not occur. 

These tests are useful in detecting more severe injuries such as intracranial hemorrhages or skull fractures, but most concussions are "software problems, not hardware problems", according to Dr. Stanley Herring, Co-Medical Director of the Seattle Sports Concussion Program and team physician for the Seattle Seahawks and Mariners.  The metabolic imbalance created by the injury cannot be adequately measured- yet. 

Diagnosis/Management

Just like any other important medical decision, it's imperative that the healthcare provider you select has experience diagnosing and managing concussions. And according to the September 2010 edition of the journal Pediatrics, while many athletes' physical symptoms resolve within 7-10 days, cognitive recovery in children and adolescents may take longer.  This suggests a more conservative approach to managing the return-to-play issue for this age group.

In 2008 an international panel of experts including SportsConcussions.org's advisors Drs. Stanley Herring and Gerard Gioia, convened in Zurich and developed return-to-play recommendations as part of the Zurich Consensus Statement.  These include:

• physical and cognitive rest until symptom-free (limit TV, texting, reading, etc)

• follow a gradual return-to-play protocol once physical symptoms resolve completely

• additional management considerations should be given to those athletes who exhibit loss of consciousness, amnesia, motor or convulsive phenomena, and/or depression

Concussions must be treated individually, and there is no set schedule for recovery. Therefore, predicting an outcome without medical evaluation is not only unwise, it can be dangerous.

The Risks

Many athletes are lucky and return-to-play with symptoms such as headaches, dizziness, light sensitivity, etc. and life goes on.  But ask Zackery Lystedt, Adrien Gault, Matthew Newman, or Drew Swank's parents what they wish had happened differently for their families.  As Dr. Herring stated recently, "You're playing "Russian Roulette" with your child's life if you don't seek medical attention for a concussion.  Return-to-play is a medical decision and one that must be given very careful consideration."

Complicated outcomes for premature return-to-play include prolonged concussion recovery or second impact syndrome, a rapid, uncontrolled swelling of the brain which can be fatal.

Point of Reference

New NFL return-to-play guidelines adopted

 The NFL adopted new, stricter concussion guidelines beginning with the 2010 season.  Now a player who exhibits certain signs or symptoms must be removed from a game and cannot return to compete the same day.  Once removed they must meet the following return-to-play criteria:

• fully asymptomatic at rest and after exertion

• normal neurological exam

• normal neuropsychological testing

• cleared by a team physician

• cleared by an independent neurological consultant 

Related article:

NFL Changes Return-to-Play Rules for Concussion