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SPORTS-RELATED CONCUSSIONS
(April 2005)

Sports-related concussions have become an increasing health and safety issue across a wide range of sports at the professional, semi-professional and college levels, and high schools are no exception. While concussions are often an unintended result of participation, it is an injury that nevertheless requires careful identification and management to avoid unnecessary long-term consequences. Formal concussion management programs began with the NFL in 1995, expanded to the NHL in 1997 and have since been implemented across numerous professional, semi-professional and collegiate programs. This same level of care and management is now being applied, perhaps most importantly, at the high school level.

• CDC estimates that there are approximately 300,000 sports concussions per year, most of which occur in high school athletics
• 85-90% of concussions do not involve loss of consciousness
• Concussions can occur without direct contact to the head
• Concussions are the second most reported injury in high school athletes behind only ankle injuries
• Only about half of high school football concussions are actually reported

In addition, recent research with high school athletes has demonstrated that:

• They are more symptomatic from mild concussion than previously believed
• Recovery times are prolonged compared to college athletes
• Second Impact Syndrome, an almost always fatal condition that results from unresolved injuries, has only been documented in teenaged athletes

When concussions occur there is a general consensus that athletes who exhibit signs and symptoms of a concussion should not return to play while they are symptomatic. Symptoms may include physical, cognitive or emotional issues and all symptoms should be resolved before an athlete is allowed to return to play.

Once symptoms have been determined by the treatment team to be resolved at rest, the athlete is allowed to begin the return to play process. Recommendations are that the athlete needs to remain symptom-free at each step of increasingly demanding physical activity, which culminates in game play. Each step usually occurs on a separate day and any return of symptoms halts further progression until the activity can be completed without symptoms.

RETURN TO PLAY GUIDELINES
1. No activity
2. Light aerobic activity (stationary cycling)
3. Sport-specific training (running in soccer, skating in hockey)
4. Non-contact practice
5. Full contact practice
6. Game play

The goal of any concussion treatment protocol should be to return athletes to play as quickly and as safely as possible. The truly disruptive situations typically arise when a player is allowed to return to play too soon and their injury is compounded by further collisions and impacts. It is the cumulative effects of unresolved concussions that need to be avoided to provide the safest and best athletic experience for the student-athlete.

– Michael Czarnota, Ph.D.
Farmington Hills