You are Benched

Athletes with concussions encouraged not to participate until fully healed

(RxWiki News) Not so fast. Head injury still bothering you? You might not be allowed to play just yet. "No athlete diagnosed with a concussion should return to play on the same day or while symptomatic," the authors of a recent report said.

This statement is designed to help doctors better care for patients with concussions while helping them become more competent in their own practice.

Athletes with severe head injuries need to be completely clear of concussion symptoms before returning to the game, according to a statement released by the American Medical Society for Sports Medicine (AMSSM) last month.

"Take headshots seriously! Check with a trainer."

The organization includes a variety of sports medicine doctors who aim to connect sport medicine knowledge with patients in a clinical setting.

The position - written by Kimberly Harmon, MD, from the Family Medicine and Orthopaedics and Sports Medicine at the University of Washington, and colleagues - is meant to help doctors evaluate concussions from sports injuries and care for their patients.

Once approved for activity by a licensed healthcare provider, AMSSM said that athletes should return to their sport gradually, with demands and risks increased one step at a time rather than fully immersing in play and practice.

Symptoms must not be present either before or after the athletes exert themselves. In addition, AMSSM recommended that athletes have a neurological and cognitive examination and balance test.

Approval to play should be determined on a case-by-case basis, the committee said, since it takes days to weeks for athletes to properly heal, depending on the situation.

The organization recommended that only licensed healthcare providers trained in evaluating and managing concussions be able to approve athletes' return.

Those healing from concussions are more at risk of getting injured again or finding themselves with another concussion. Their decreased reaction time concerns officials.

“There is increased awareness and visibility for sports-related concussion in athletes of all ages," said co-author Jonathan Drezner, MD, team physician for the University of Washington and the Seattle Seahawks and current president of the AMSSM Board of Directors, in a press release.

"This statement provides a scientific framework for the evaluation and management of concussion. Sports medicine physicians are uniquely positioned to help patients, parents, and coaches understand and achieve a safe return to play.”

Coinciding with previous research, exposing the head to injuries and getting hit repeatedly can cause long-term brain and neurological problems.

If head pains return after the intensity of play has been increased, AMSSM recommended that athletes back down to the previous level and ensure symptoms stop completely.

The stance on pulling athletes out when injured hasn't changed, according to Dan Clearfield, a primary care sports medicine physician and dailyRx Contributing Expert. Advances in brain imaging techniques, testing, and medication management have been updated, he said.

"In regards to pulling out of play when concussion is diagnosed or suspected, this stance has not changed since the previous consensus statement ('when in doubt, sit 'em out'),..." he said.

"When we diagnose concussion on the sideline...the athlete is pulled from play and not allowed to return that same day, and evaluation and clearance by a physician trained in the management of concussions is required before they are allowed to proceed with the return to play protocol.

According to the statement, 3.8 million concussions occur in both competitive and recreational sports activities across the US each year. Up to 50 percent of these severe head problems go unreported.

Currently, there's no scientific evidence in support of retiring athletes completely from their sport after they have had a concussion. The statement said that each case should be measured individually.

AMSSM said that future research should see how well tools that measure concussions work and improve ways to identify long-term concussion complications and symptoms. The study was published in the January issue of the Clinical Journal of Sport Medicine.

Review Date: 
January 9, 2013