The New Updated Concussion Guidelines
As athletes, sports we play have a significant probability of incurring trauma to the head. Concussion has become a household term, but do we truly understand what a concussion is? No…well don’t worry you are not alone. In fact even the leading minds in concussions and concussion associated symptoms have to meet every four years to collaborate and create a consensus on: what constitutes a concussion, how do we evaluate someone for a concussion, what do we need to know to return that player to sport safely, and more. The purpose of this article is to review the current definition of concussion, the common symptoms and signs and the return to play guidelines as set forth by the most recent collaborative conference on Concussion.
“Concussion is a brain injury and is defined as a complex pathophysiological process affecting the brain, induced by biomechanical forces”
a) It may be caused by a direct blow to the head, face, neck or elsewhere on the body with an impulsive force transmitted to the head
b) It usually results in short-lived impairments of neurological function
c) The acute clinical symptoms largely reflect a functional disturbance (i.e. no evidence is seen on structural neuroimaging)
d) Concussion results in a graded set of clinical symptoms that may or may not result in a loss of consciousness.
Return Safely to Play
85 – 90% of concussions resolve in 7-10 days. During this time, the currently agreed upon consensus would have us do the following steps in order for us to safely return to play”
1) Initial rest period (no activity) of 24-48 hours. The purpose is for recovery.
2) Light aerobic exercise like walking or light swimming. The purpose here is to see how the symptoms respond to an increased heart rate (try not to exceed 70% maximum heart rate at this stage)
3) Sport-Specific exercise like light skating or soccer drills for example. The purpose of this stage is to add more movement with the increased heart rate.
4) Non-contact training drills. At this point the player should be practicing in all drills and can start resistance training. The purpose is to see how exercise, coordination and cognitive load affect the symptoms.
5) Full contact practice should always be done before going back into a game situation. It helps to restore confidence and allows assessment of the players functional skills
6) Finally return to play
How to Manage the Steps
The above steps are to be progressed in a day-by-day manner, where step by step progression occurs only after a full day without concussion like symptom exacerbation. Therefore if you attempt some non-contact training drills and the symptoms come back, than you revert back to sport-specific exercise the next day. It is also important to mention that if you are taking any medications for these symptoms, that return to play should not be allowed until you are able to do full contact practice without the aids of medication.
In the smaller amount of cases of concussions that linger past 10 days (roughly 10-15%), after attempting the above steps, it is advised that the person manages the concussion in a multidisciplinary manner. This is where we at the Urban Athlete can help, providing a proper assessment of the neck as many concussion-like symptoms can be reduced with proper treatment.
This is a very brief overview of concussion but for further information click the link below to read the actual article “Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport held in Zurich, November 2012”.
We want our athletes to participate in a wide range of sports, and sometimes the most aggressive ones are the most fun to play and watch, but we urge you to play safe.
Dr. Shaun, The Urban Athlete