By: Andy Baer, MD
While statistics vary, it is clear that several million student athletes suffer sports-related concussions each year. As many as half of them go undetected or unreported — which is problematic, as athletes who return to play without allowing their brain to heal may set themselves up for serious long-term consequences, including memory, balance, sleep and mood issues and chronic headaches.
Widely publicized incidents and reports from both amateur and professional sports have raised awareness about the impact of concussions, and the old days of simply writing a note allowing a student athlete to resume school and sports are gone. Returning a young athlete to play should be based solely on the individual and their symptoms and progress, rather than a standardized period for recovery. This requires a team approach and clearly defined processes designed to send an athlete back to school and sports at the optimal time.
Assembling the Concussion Team
In addition to physical well-being, a concussion can affect a student athlete’s cognitive abilities and emotional state. Because the impact can be wide, determining the appropriateness of return to school and play is best accomplished with a multi-disciplinary team approach. Having several sets of eyes on the concussed athlete can help ensure that they have returned to full functionality.
Individuals who regularly interact with the student athlete should help manage the concussion, monitor symptoms and provide written and periodic observations about their recovery to determine the best course of action for the injured person. The members of the team and involvement of professionals will vary according to each case and resources available. In addition to the medical provider and the athlete, the concussion team typically includes parents or guardians, teachers, school nurses, coaches and trainers.
It’s important that all concussion team members understand the severe risks involved in returning to sports before a full recovery. The medical provider or providers on the team play an important role in educating the team about those risks.
Return to School
Although the student athlete should not resume sports or activities that could cause re-injury to the vulnerable brain until fully recovered, the approach to returning to school is quite different. Transitioning the student back to school typically is possible once the most severe concussion symptoms have improved — usually within one to three days. The student, parents and physician may need to work with the school for specific accommodations so that symptoms can continue to improve while keeping the student engaged in learning.
Return to Sports
Returning an athlete to participate in a sport can only begin once they have fully recovered from the concussion. The athlete must be symptom-free and have returned to baseline regarding school performance, which means being able to tolerate a full school day with an age-appropriate workload.
Neurocognitive testing may also be helpful to assess recovery, although neurocognitive recovery may lag behind symptom resolution, theoretically indicating an athlete whose brain is still at risk. Adolescents with concussions may have subtle neurometabolic derangements that may dramatically increase the risk of long-term and potentially severe or life-threatening complications if they are re-injured before recovery.
Once the medical provider has determined that the athlete has fully recovered, it’s time to begin the Graduated Return-to-Play Protocol as recommended by the Consensus Statement on Concussion in Sport1 published in 2017 (also available on multiple websites by searching “Graduated Return-to-Sport Protocol”). When the athlete successfully completes this graduated return-to-play process — which typically requires a minimum of seven days after they are asymptomatic at rest — they can receive final clearance to return to full participation.
At all points in this process, physicians should thoroughly document the resolution of the symptomatic and neuropsychological consequences of the concussion.
Resources for Managing Concussions
Many tools are available to assist concussion teams, including:
- Dr. Karen McAvoy, the author of REAP (Reduce, Educate, Accommodate, Pace), provides a summary of the multidisciplinary team approach. The REAP booklet2 guides concussed athletes and their teams through the recovery process.
- The Centers for Disease Control and Prevention (CDC) offers extensive guidance for healthcare providers, coaches, schools and parents in its Heads Up3 guide, including an Acute Concussion Evaluation (ACE)4 tool.
- The Sports Concussion Assessment Tool (SCAT 5) is another concussion-tracking tool. Many websites post this tool; you can find it through a Web search of “SCAT 5.”
Clearing a student athlete to participate in sports too soon after a concussion can lead to life-threatening complications. Returning a young athlete to their sport post-concussion requires a systematic and thoughtful process. But even with a careful approach, a poor outcome still is possible. Every parent and youth athlete must weigh for themselves the risks and benefits of continuing in competitive sports after suffering a concussion.
1 https://pubmed.ncbi.nlm.nih.gov/28446457/
3 https://www.cdc.gov/headsup/index.html
4 http://www.cdc.gov/headsup/providers/index.html
Disclaimer: The information provided in this article does not constitute legal, medical or any other professional advice. No attorney-client relationship is created and you should not act or refrain from acting on the basis of any content included in this article without seeking legal or other professional advice.
Andy Baer, MD is the Chief Medical Officer at MagMutual. https://www.magmutual.com
