Anyone who has a head injury during a sporting event needs to immediately stop all activity and not return to play that day. Being active again before the brain returns to normal functioning increases
the person's risk of having a more serious brain injury.
Every person involved in a sporting event (every coach, player, teacher, parent, and trainer) needs to be trained to know the symptoms of a concussion. And all need to know the importance of getting medical help when a player has a head injury.
The decision about when a player can safely return to play must be made by a doctor. The doctor decides on a case-by-case basis. Things that help the doctor decide when the player can return to play include:
Doctors and other concussion specialists agree that a player must not return to play until symptoms are completely gone, both at rest and during exercise or exertion. Using medicine to improve concussion symptoms is not the same thing as being symptom-free. Medicines must be stopped before an athlete can be considered symptom-free. Children and teens have longer recovery times. So they may have to wait longer before they can return to play.
The first treatment for a concussion is rest, both physical and mental. The return to play needs to occur in a gradual, step-by-step way:1
The athlete must be symptom-free for 24 hours at the current level of activity before moving on to the next step. If one or more symptoms return, the player needs to go back to the previous level of activity with no symptoms for at least 24 hours before trying to do more. A doctor must always make the final decision about whether a player is ready to return to full-contact play.
These general rules apply to return to play after a first concussion. After more than one concussion, the player will most likely need a longer recovery time. Because the risk for a second concussion is greatest within 10 days of the first concussion, it's very important to make sure the player is completely recovered before he or she returns to play. A second injury, even if it is not a head injury, could cause permanent brain damage or death.
McCrory P, et al. (2013). Consensus statement on concussion in sport: The 4th international conference on concussion in sport held in Zurich, November 2012. British Journal of Sports Medicine, 47(5): 250–258. Also available online: http://bjsm.bmj.com/content/47/5/250.full.
Other Works Consulted
American College of Sports Medicine (2006). Concussion (mild traumatic brain injury) and the team physician: A consensus statement. Medicine and Science in Sports and Exercise, 39(2): 395–399.
Halstead ME, et al. (2010). Sport-related concussion in children and adolescents. Pediatrics, 126(3): 597–615.
November 29, 2011
Anne C. Poinier, MD - Internal Medicine
& William H. Blahd, Jr., MD, FACEP - Emergency Medicine
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