"When In Doubt, Sit it Out" Part of New Concussion Guidelines

Though the potentially devastating consequences of a brain concussion are often hard to determine except over time and with the help of trained medical professionals, countless athletes often face the question of how soon they can resume sports after an injury.   Up until now,  established procedure involved "grading" concussions according to perceived seriousness, usually by medics or coaches on the field which has raised concerns about possibly missing more serious injuries which can be made worse by repeated concussions.    As part of an initiative to provide better protection for athletes, whether professional or amateur, The American Academy of Neurology (ACN) has issued revised guidelines concerning proper assessment and treatment of concussions.   Replacing previous guidelines dating back to 1997, the new guidelines are based on the latest research into the brain injuries most often seen in athletes.   Recognizing that as many as 3.8 million concussions occur each year,  the ACN warns that many athletes fail to get proper treatment because warning signs often go unnoticed.  

Among the recommended ACN guidelines are:

  • While concussions can happen in any sport, they are most common in males playing American football or rugby or in females playing soccer or basketball
  • Concussion is a clinical diagnosis.  Though field assessments using established symptom checklists or rating systems have become more common in recent years to grade concussions, they are not always reliable.
  • Any athlete who appears to have had a concussion should be removed from the game and not returned until after a thorough medical evaluation
  • Athletes who have had a concussion are at increased risk from further concussions.  For that reason, they should not return to play or participate in any activity where a new concussion might occur until a licensed medical practitioner "had judged that the concussion has resolved".   The ACN guidelines do not set a timeline for safe return to contact play.
  • The period of greatest danger is the first ten days after a concussion occurs and athletes should take special care to avoid follow-up concussions during that time
  • Athletes with a history of multiple concussions and symptoms suggesting cognitive or neurological problems should undergo special evaluation to determine the full extent of injury.  That may include a recommendation that the athlete retire from play completely.

The ACN guidelines are designed with the latest research in mind but also recognize that research into brain concussions is ongoing and that new findings may lead to changes in how coaches and athletic trainers should handle injured athletes.  According to Dr. Jeffrey S. Kutcher, associate professor in neurology at the University of Michigan Medical School and co-leader of the panel forming the new guidelines, "If in doubt, sit it out" is a key precaution that coaches and athletes need to remember.  "If headaches or other symptoms return with the start of exercise, stop the activity and consult a doctor," he added.  

According to the Center for Disease Control and Prevention, concussion symptoms usually fall into four categories:

  • Thinking/remembering symptoms such as difficulty remembering new information, feeling slowed down, trouble concentrating, and difficulty thinking clearly
  • Physical symptoms including headaches, dizziness, light sensitivity, fatigue, lack of energy, and (early on) nausea or vomiting
  • Emotional symptoms including sadness, irritability, nervousness/anxiety
  • Abnormal sleep pattersn such as excessive\insufficient sleep or trouble falling asleep

Symptoms can occur immediately after a concussion or can appear days or months after the injury.  In many cases, athletes may prefer not to admit to experiencing symptoms due to the fear that it might prevent them from being allowed to play.   Despite worries, persistent concussion symptoms should never be ignored, especially if there is a possibility of further concussions that can worsen the problem. 

While the new concussion guidelines are still a work in progress, increased awareness of the danger posed by sports-reelated concussions are intended to ensure that athletes at all levels of play will be able to prevent the kind of crippling injuries that can prematurely end a sports career.   As athletes, coaches, and family members mobilize to incorporate safe practices into all aspects of contact sports, we can hope that there will be fewer tragedies linked to repetitive head injuries. 

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