Concussion guidelines are a rapidly changing field. Just a few years ago, athletes were expected to “shake it off” and continue to playafter suffering a concussion or a “ding.” Today, we now know that it is unsafe for any athlete to return-to-play the same day they have suffered a concussion, and it is recommended that every athlete not return-to-play until they have been cleared by an appropriate medical professional.
Athletes who do return early are at risk for Second-Impact Syndrome (SIS), a rare but catastrophic brain injury in which an athlete who has suffered a concussion incurs further brain trauma before symptoms associated with the initial concussion have cleared. About 50% of athletes die after suffering SIS and the rest suffer life-long impairments.
In addition, athletes that return to play too soon also risk additional brain damage due to what is termed the “neurometabolic cascade of concussion.” This paper, by Giza and Hovda, also provides insight into what actually happens inside the brain during a concussion, which is best described as a process, not an event.
Concussion comes from the Latin word “concussus,” which means “to violently shake.”
Diagnosing a concussion is not an easy matter. There are multiple definitions, but we like“a trauma-induced change in mental status.” The definition is broad, and the signs and symptoms of concussion are many.
Determining appropriate return-to-play after concussion is not easy. For perspective on current guidelines, historically athletes have returned-to-play the same day after suffering a concussion with loss of consciousness.
More recently, in many programs athletes were expected to RTP if their symptoms “cleared” or “disappeared” within 15 minutes. However, the tests used to determine “cleared” were often a simple direct question to the athlete (“Are you good to go?”) or a series of sidelines tests of cognitions, balance, etc. that were not sensitive enough to catch subtle “alterations in mental status.”
The most recent guidelines and consensus statements firmly state that no youth athlete should return to play the same day, and should not return after that day until they have been cleared by an appropriate medical professional.
- Read the Zurich Consensus Statement 2008 here.
- Read the National Federation of High School Associations RTP Guidelines here.
However, SLI would not be surprised if the guidelines were revised in the future to become even more conservative, as scientific tests for post-concussion brain abnormalities become more sophisticated.
Dr. Cantu is a member of the Sport Neurotrauma and Concussion Initiative Research Committee that oversees the Sports Concussion Library, led by Paul Echlin M.D. The site includes more than 2,300 peer-reviewed journal articles, 61 book chapters and entries on thesis research, concussion legislation on the federal, state and provincial levels, filmed documentarie,s and a downloadable SCAT2 test, the standard sideline concussion assessment tool. Dr. Cantu was also featured in US Lacrosse informational video about concussions. Watch here.