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Same-Day Return-to-Play No Longer an Option for Concussed Athletes

by User Not Found | Nov 16, 2011
Revised consensus statement better guides team physicians in concussion management

INDIANAPOLIS – Team physicians who assess and treat athletes suspected of concussion have new marching orders from the American College of Sports Medicine (ACSM), according to a team physician consensus statement released today. Under no circumstances should an athlete suspected of, or diagnosed with, a concussion return to play the day of their injury.
 
“There is to be no same-day return-to-play after a concussion, even if the athlete’s initial symptoms resolve as the athletic event or practice progresses,” said Stanley A. Herring, M.D., FACSM, chair of the writing group and one of the team physicians for the Seattle Seahawks and Seattle Mariners. “Also, the subsequent decision to return an athlete to play should be individualized, not based on a rigid timeline or solely on the demands of a particular sport.”
 
The team physician consensus statement, titled “Concussion (Mild Traumatic Brain Injury) and the Team Physician: A Consensus Statement – 2011 Update,” updates recommendations made in 2006. While advising against same-day return-to-play is the biggest change from the 2006 statement, there are other changes team physicians should note.

  • Physicians should use standardized concussion assessment tools, such as the NFL Baseline and Sideline Tools, for pre-season and post-injury evaluation. Neurological assessments should emphasize cognitive function, cranial nerve and balance testing.
  • Physicians should use the preseason to develop an emergency medical action plan, including a specific plan for concussion management, and they should also assemble a concussion management team.
  • Neuropsychological (NP) testing is one component of the evaluation process, and it should not be used as a stand-alone tool to diagnose, manage or make return-to-play decisions in concussion. 
  • Tests using event-related and evoke-related potentials, as well as tests using biomarkers, have been inconclusive in identifying individuals with concussions; however, they may one day be applicable. 
  • Physicians should understand their states’ laws regarding concussion as well as the rules and regulations from their sports’ governing bodies.

“There are more than 3.8 million concussions suffered in sports and recreational activities each year,” said Herring. “Proper management by team physicians is crucial because it can mitigate potentially life-threatening complications.”
 
Before returning to play, an athlete should have no symptoms (at rest or with cognitive effort), should not be taking any medications to mask concussion symptoms and should be back at baseline with their neurological examinations and NP testing if available. The process may take days, weeks or months, and the recurrence of symptoms should warrant additional rest and monitoring.
 
A concussion is a brain injury resulting from linear (the brain directly hitting the skull) or rotational (the brain swirling forcefully in the skull) accelerations following impact. Concussions occur in helmeted and non-helmeted sports, and they are most common in football, ice hockey, soccer and lacrosse.
 
“Concussion (Mild Traumatic Brain Injury) and the Team Physician: A Consensus Statement – 2011 Update” was a collaboration among ACSM, the American Academy of Family Physicians, the American Academy of Orthopaedic Surgeons, the American Medical Society for Sports Medicine, the American Orthopaedic Society for Sports Medicine and the American Osteopathic Academy of Sports Medicine.
 
The team physician consensus statement is published in the December 2011 issue of Medicine & Science in Sports & Exercise®, the official journal of ACSM. Members of the media can view the full statement online at http://www.acsm-msse.org.

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The American College of Sports Medicine is the largest sports medicine and exercise science organization in the world. More than 45,000 international, national and regional members and certified professionals are dedicated to advancing and integrating scientific research to provide educational and practical applications of exercise science and sports medicine.

Medicine & Science in Sports & Exercise® is the official journal of the American College of Sports Medicine, and is available from Lippincott Williams & Wilkins at 1-800-638-6423. For a complete copy of the team physician consensus statement or to speak with a leading sports medicine expert on the topic, contact the Department of Communications and Public Information at 317-637-9200 ext. 133 or 127.

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