Concussions and Return to Play

By Julie Wiekamp, MPAS, PA-C

If you live in Nebraska, it is nearly impossible to escape the hype and excitement that comes with Husker football. Every fall, Memorial Stadium is full of passionate fans, ready to cheer on their favorite player. On game day, the fans at Memorial Stadium are heard from miles around. Yet, nothing quiets the stadium like a bad head injury.

Traumatic brain injuries are most often caused by some type of accident. Motor vehicular accidents and falls are the most common causes. However, athletes in recreational sports such as football, hockey, soccer, and boxing are especially prone to head injuries. Sports related concussion is found to affect somewhere between 1.6-3.8 million athletes annually.

Concussion is just one type of traumatic brain injury. Concussion most often occurs through a direct blow to the head. One does NOT have to lose consciousness to have a concussion. Loss of consciousness may be a symptom of concussion, but many concussions go unrealized because the individual did not lose consciousness. Concussion symptoms include confusion, loss of memory, mood changes, difficulty concentrating, poor coordination, stumbling and slurred speech. Anyone suspected of concussion should be evaluated by a health care provider. Acute bleeds to the brain and skull fracture must be ruled out first. Imaging, such as CT, may be necessary for some injuries.

Several sideline tools have been developed to aid in the diagnosis of concussion. The SCAT5 may be used by licensed health care professionals to evaluate concussions. Athletes are usually tested before the season, and again if a concussion is suspected.

In general, all athletes with concussion must be removed from play until given clearance to return by a health care provider. A step-wise return to play protocol is initiated. First, athletes should be symptom free off medication and able to return to schoolwork without problem. Neurological testing(SCAT5) should be back at baseline. Only then, may athletes begin to participate in light aerobic exercise followed by a gradual return to full play. A minimum of 5 days is required before even considering a return to play.

It is very important that athletes return to play slowly and per protocol. Athletes who have not fully recovered from concussion are at a much higher risk of sustaining a second concussion. A second injury to the brain, when it is not fully healed, may result in long term or even fatal consequences.

Most individuals with concussion go on to do quite well long term. Most high school athletes are able to return to play within a few weeks.

For more information regarding concussions and return to play:

When In Doubt, Sit ‘Em Out

J. Wiekamp