Over the past several years there has been a dramatic increase in awareness of concussions, both nationally and internationally. Whether we are talking about little leagues, high school, college or at the professional level, everyone involved (parents, coaches, athletic trainers, physical therapists and physicians) is well aware of the risks of concussions and more importantly the danger of prematurely returning an athlete to play again.
In New York State, at the high school level, we have instituted laws to protect athletes with concussions from returning to play too soon. An athlete with a concussion, once asymptomatic, will have to complete a 6 day return-to-play protocol, guided, in all likelihood, by the athletic trainer.
Post-Concussion Return to Play Protocol
The long term risks and consequences of repeated head injuries and the guidelines established by the state of New York, have caused the district to re-address our return-to-play protocol following concussions. Where previously, we would accept the private physician’s medical clearance for an immediate return to practice and competition, the physician’s clearance is now one part of several measures we use for a student’s readiness to return. These protocols were developed in conjunction with our school athletic trainer, physician assistant, district physician and the NYSPHSAA (New York State Public High School Athletic Association’s) return to play protocol and are based upon the newest international recommendations for management of head injuries and have been approved by the district administration and adopted as best practice by the New York State Public High School Athletic Association and locally by Section V Athletics.
We have initiated the ImPACT Testing (Immediate Post-Concussion Assessment and Cognitive Testing) for an athlete which establishes a baseline to aid in managing suspected head injuries. If an athlete receives a head injury, they will be required to take a post-injury test. Both the baseline test and the post-injury test data can be given to either a family doctor or the district physician to help evaluate the injury.
If a student receives any type of head injury during an athletic practice or contest, they will not be allowed to resume the activity that day. Accordingly, when a student sustains a head injury diagnosed as a concussion, they must be medically cleared by a private physician and remain completely symptom-free for at least 24 hours before a return-to-play is allowed. Even then, there is a mandatory six day graduated return-to-play schedule that must be followed. If symptoms return at any point during this re-training period, the process is suspended, and the student must be symptom-free again for 24 hours, at which time, the graduated re-entry plan starts over.
This protocol applies to the first mild concussions that an athlete experiences. More serious concussions, for example, if there is any loss of consciousness, and subsequent concussions, carry more risk and require a longer process. In these cases, the protocol will be individualized and determined by the athletic trainer, private physician and school physician working together. All final decisions about clearance for participation in school athletics will be determined by the school physician.
No day may be skipped to speed up the process of full return-to-play. Due to the extreme risk factor, no exceptions will be made to this re-entry process for any reason. Medical literature has demonstrated a repeat of even a minor blow to the head of a previously injured child who is not fully recovered can lead to permanent brain damage and even death. Because there is no way to know whether a headache, nausea, confusion, memory issues, and similar symptoms that persist are related to either post-concussion symptoms or to an inter-current illness, such as sinusitis, the “flu”, or other conditions, we have made the deliberate decision to err on the side of caution. Our ultimate goal is the health and well being of the student-athlete.
It is important to understand that we have developed this protocol in order to ensure the health and safety of the student-athlete. As a sports medicine physician, I feel it is crucial to educate the student-athlete in the importance of following a graduated re-entry to play after experiencing a head injury.
In addition, I recommend the following during recovery from a concussion:
- Rest your brain. This includes sleeping more if you need to.
- Avoiding caffeine in all forms and other stimulants.
- Do not take unnecessary medications (read the labels as many over the counter meds have caffeine).
- When watching TV pick a re-run of a sitcom that is familiar to you rather than a drama or mystery that will tax your brain.
- Save your brain for homework and school work not on texting and surfing the net.
- Enlarge the font when possible when you are reading.
- Avoid the things you know are bothering you, (i.e., bright lights, loud noises, crowds, and driving in heavy traffic).
- Follow your athletic trainer and physician guidelines for activities and do not “jump ahead” in your physical activities as you may delay the healing process.