Advancements in Return to Play

 

When it comes to concussions there has been incredible advancement regarding management and diagnosis. Not long before I started in my concussion treatment journey the management strategy regarding Return To Play (RTP) was vastly different than it is today.

According to an article published in the journal of the American Family Physician (1999) “If concussion symptoms clear away within 15 minutes and if no associated loss of consciousness or post-traumatic amnesia has occurred, the athlete may return to play that day. Some guidelines would permit an immediate return to play once the player is asymptomatic; others recommend a 15- or 20-minute wait after symptoms have disappeared.”

WHOA!  While clearly we still see this kind of management at the elite level of sports it is NOT the recommended way to handle an athlete who sustained a concussion or suspected of sustaining a concussion. Unfortunately, many of the parents and coaches involved at every level of sport  still maintains this protocol as a primary RTP model. I’ve personally encountered this both professionally and as a parent of a young athlete.

Fast forward to 2012 and the consensus statement on concussion in sport: the 4th International Conference on Concussion  released by the British Journal of Sports Medicine. Here we have a 0-6 stage model of RTP. In this model it recommends a 24hr wait time between stages to ensure that there is enough time for the body to adjust and monitor for symptoms. This stage SHOULD take about a week to complete. However, once you provide the guidelines the rest is in the hands of the athlete/coach/parent. And not everyone follows the rules.

For example, I had a young man in his 20’s come in for treatment for his concussion. 2 sessions and his symptoms were gone. Does this mean he can immediately RTP?

No. I advised him to go slowly and follow the protocol. And he didn’t follow the rules.

Here is how it went down: He came in for session on a Tuesday. Immediately after session he feels great. I go over the rules, emphasizing “Even if you feel great, DO NOT push your RTP.”. Followed up Tuesday evening. Still feels fantastic. Wednesday morning. Still good. Wednesday night goes to practice and does Stage 1. Feels good so thinks what the heck, I’ll do stage 2. Still no symptoms. Moves up to stage 3 and so on until he does all 6 in one evening. Calls me Thursday morning. Feels crummy. Comes back for a reset treatment. Feels awesome. Doesn’t violate the rules again and gets back into the game with no adverse effects.

Take away lesson? Let your body heal, you have a lifetime in it.

 

Jenna

 

 

 

Am Fam Physician. 1999 Sep 1;60(3):887-892.

Br J Sports Med  2013;47:250-258   doi:10.1136/bjsports-2013-092313