Sports and recreation-related concussions (SRRC), a form of mild traumatic brain injury (mTBI), are a very common and heavily publicized injury in sports medicine.
Sports and recreation-related concussions (SRRC), a form of mild traumatic brain injury (mTBI), are a very common and heavily publicized injury in sports medicine. This is especially noteworthy given the potentially severe ramifications of continuing to play after sustaining a concussion or multiple concussions. Due to a national spotlight on concussions, especially in the National Football League (NFL) as well as college and youth leagues in all sports, there have been rapidly changing rules governing concussion management.
Additionally, there has been a growing effort in the research surrounding concussions. Subsequently, there is an expanding body of knowledge within the medical community to help develop guidelines in the evaluation, treatment, education, and return to play criteria of patients with concussions. This provides sports medicine physicians with a road map to follow to efficiently and, most importantly, safely return athletes back to sport.
In general, the accepted protocol for returning to full contact play involves graduated return to school full time, or in the case of non-student athletes, other activities of daily living, followed by a five-step graduated return to play algorithm using symptoms as a basis of when the athlete can progress to the next step. There are also a variety of tools that can be used for evaluation of SRRC which include the following: Sport Concussion Assessment Tool 5 (SCAT5), Sway, Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT), King-Devick, and multiple clinical tests such as vestibulo-ocular motor scoring (VOMS) or Balance Error Scoring System (BESS) testing. Similar to the significant number of tools available for the evaluation of concussion, there are just as many, if not more, different methods of managing concussions.
These include rest, fish oil, buffalo protocol, balance therapy, vision therapy, osteopathic manipulative therapy, anti-inflammatory medications, modalities such as electrical stimulation, among others. The buffalo protocol, or some modified version of graduated exercise testing to sub-symptom exacerbation threshold, is frequently utilized in managing athletes with prolonged post-concussive symptoms (PCS). Example of concussion return to play protocol (courtesy of sycva.com) This robust amount of data and clear return to play guidelines make managing uncomplicated concussions relatively straightforward for physicians.
Unfortunately, in rare cases, athletes may present with concussion-like symptoms but have the more dreaded moderate traumatic brain injury. The definition of moderate traumatic brain injury is inconsistent in the literature. A moderate TBI can be defined as prolonged loss of consciousness (typically greater than 20 minutes but no more than 24 hours), post-traumatic amnesia lasting for up to 24 hours, glasgow coma scale (GCS) of 9 - 13 and/or abnormal neuroimaging.
If you are experiencing symptoms that may be related to the conundrum of return to play after moderate tbi, it is important to see a sports medicine physician. Early evaluation and treatment typically lead to better outcomes. Do not ignore pain or symptoms that are limiting your activity.
*This article is for educational purposes only and does not substitute for professional medical advice. Always consult a qualified healthcare provider.*
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