Keeping Athletes in the Game
Sport-Related Concussion: Current Research and the Importance of Gradual Return-to-Activity Protocol
The continued rise in popularity of high school athletics brings new awareness about the world of sports medicine and the prevention and care of athletic injuries. Lately, much of this interest pertains to the prevalence of sport-related concussions and how coaches, athletic trainers, and physicians work together to treat concussions and ensure a safe return to sport for all. Many news headlines surround recent collegiate and professional athletics events concerning concussion protocols and safe return to sports. These trending developments demonstrate the importance of concussion training and community education for all involved in the healthcare of secondary school athletes and the importance of state-regulated concussion laws and guidelines for concussion management and clearance. This highlights the importance of a monitored gradual return to sport.
In the current research, groups such as the Concussion in Sport Group (CISG) are still working to define what concussions encompass and how concussions specifically impact the pediatric and adolescent patient demographic. Much of the existing research surrounding concussion focuses on adult male patients. Therefore, it has become incredibly important for groups such as the CISG to turn their attention to researching the impact of concussion in female patients as well as adolescent groups and how specifically these groups of patients respond and heal from a traumatic head injury. This lack of research makes advocacy for abidance of concussion care and return to play protocol in the secondary school setting and youth sports programs of the utmost importance.
Communication between a young athlete’s physician and parents, coaches, and athletic trainers in concussion management creates efficient, high-quality care that focuses on supervision of an athlete’s symptomology and a safe reintroduction to activities of daily living, school, and exercise that will evolve into a return to sport. In Tennessee, officials have created a policy recognizing the need for education and early management of athletes who display concussion-like symptoms (TSSAA Concussion Policy and RTP Form). If a student-athlete is evaluated for a concussion during a game and symptoms are present, they must be immediately removed to prevent further harm.
The athlete who displays symptoms of a concussion is to be referred to a licensed medical doctor (M.D.), osteopathic physician (D.O.), or clinical neuropsychologist with concussion training. These practitioners work closely with the athlete’s family and athletic trainers to ensure that the appropriate care is being provided to reduce patient symptoms and promote a healthy return to school and sports. Once said practitioner is confident that symptomology has diminished and the patient is able to complete schoolwork and daily activities without the onset of concussion symptoms, the state return to play form is signed and sent to the healthcare provider at the patient’s school. This, in most cases, is the certified athletic trainer on-site. Patients then will engage in a gradual exercise protocol that focuses on increasing heart rate and adding sport-related movement and exercise over six days until the athlete is able to return to full competition.
Recognition and communication of concussion symptomology remain essential throughout the gradual return to play protocol, as the patient must be symptom-free and free of all pain-alleviating medications to continue advancement in the protocol. It is important to note that if symptoms do return during the return to play progression, the athlete is to return to the first level of the protocol and start again. An athlete’s symptoms may include headache, dizziness, lightheadedness, nausea, and increased sensitivity to light and noise. Should symptoms persist, the athlete must communicate with the athletic trainer so that communication may be made to the treating provider to determine if additional care is necessary. This can delay the return-to-play protocol longer than the original six days. For a successful and safe return to activity, it is crucial to ensure that all parties related to the patient’s healthcare are educated on concussion symptomology and how to recognize concussion-like symptoms in high school athletes. Lack of communication regarding symptoms or deficits in an athlete’s daily activities is dangerous. Athletes who return to sport too soon and endure additional head trauma can sustain long-term side effects and ramifications pertaining to cognitive function, even into adulthood. As researchers continue to collaborate on defining the impact of concussions in adolescent populations, it is essential in our roles as educators, coaches, parents, and athletic trainers to be aware and educated on concussions to promote safe, healthy futures for today’s youth.
Resources and Education
Concussion recognition and treatment should also be considered beyond athletics, and it is crucial to understand that often there is a process for an adolescent athlete to “return to learning” just as there is a return to athletics. Student-athletes struggling in the classroom due to concussion symptomology may benefit from an IEP or 504 plan to give them the assistance they need to complete and comprehend their school lessons and work. The athletic trainer on-site at the athlete’s school can be an outstanding resource for creating an environment of collaborative care through communication with school administrators, teachers, nurses, and coaches. Getting to know your athletic trainer can provide athletes and their families with additional resources as they work diligently to advocate and provide healthcare to the athletes at their respective schools or facilities.
Further education on concussion recognition and management in sports can be found on the National Federation of State High School Association’s (NFHS) website. There the NFHS provides a free concussion course for coaches and the general public to educate themselves on how to recognize and best manage concussions as they pertain to high school athletics (NFHS Concussion Course).
HaleyWyatt is a Certified/Licensed Athletic Trainer at LeConte Sports Medicine.
Haley is currently working on her Doctorate in Sports Neurology and concussions and Higher Education leadership.