Last time we talked about what concussions are and how they are treated. I would like to take this opportunity to write about concussion and sports. I have had several parents contact me about their children having concussions or concussion like symptoms. Often, the questions that are most commonly asked are “Should my child participate again?” and “When can my child safely participate again?”
As physicians, there are no hard and fast rules on concussions. However, there are some simple guidelines that are widely agreed upon, that serve as a framework for participation for athletes that have sustained a concussion.
I would like to review these guidelines to inform parents of what is reasonable to expect when their child suffers a concussion.
As a review, according the American Academy of Neurology, there are three major concussion grades:
1. Grade I: Transient confusion and concussion symptoms less than 15min with no loss of consciousness.
2. Grade II: Transient confusion and concussion symptoms for greater than 15 min with no loss of consciousness.
3. Grade III: Concussion symptoms with loss of consciousness for any amount of time.
The following are set guidelines for return to play for athletes that have sustained a concussion. These guidelines are compiled from review of multiple sets of guidelines, including those from the American academy of Neurology and the Colorado Academy of Neurology:
- Grade I: 1st concussion - return to play when asymptomatic for 20 minutes; 2nd concussion - return to play when asymptomatic for one week.
- Grade II: 1st concussion - return to play when asymptomatic for one week; 2nd concussion - return to play when asymptomatic for one month.
- Grade III: 1st concussion - immediately transport to hospital for evaluation, return to play one month after injury if asymptomatic for two weeks; 2nd concussion - immediately transport to hospital for evaluation, immediately terminate season.
Anytime a player sustains a concussion, the player should immediately be removed from play and evaluated. The player should be reevaluated frequently, about every 5 minutes until the symptoms of concussion (confusion, dizziness, headache, and unsteady gait) have resolved. If the determination is made that a player should not return to play, it is important to take away an important piece of equipment, such as a helmet or shoe, to prevent the player from reentering play. This is not to say that a coach would willingly send a player with a concussion back in the game. Rather, in large team sports such as football, confusion can exist on the sideline. A player may not remember the concussion or may disagree with the decision and may ask to return, even though they should not. Taking away important equipment from the player simply removes the possibility of them returning to play before it is appropriate, which protects everyone involved, most importantly the player.
Dr. Christopher Munger’s column appears every other Sunday. Dr. Munger is board-certified in family practice. He is a member of the Family Health Care Center in Statesboro and admits patients to East Georgia Regional Medical Center. He is originally from California. He received his bachelors degree from UCLA, his medical degree from Columbia University in New York City and completed his training in family practice at the University of Virginia. He lives in Statesboro with his wife and two dogs.
As physicians, there are no hard and fast rules on concussions. However, there are some simple guidelines that are widely agreed upon, that serve as a framework for participation for athletes that have sustained a concussion.
I would like to review these guidelines to inform parents of what is reasonable to expect when their child suffers a concussion.
As a review, according the American Academy of Neurology, there are three major concussion grades:
1. Grade I: Transient confusion and concussion symptoms less than 15min with no loss of consciousness.
2. Grade II: Transient confusion and concussion symptoms for greater than 15 min with no loss of consciousness.
3. Grade III: Concussion symptoms with loss of consciousness for any amount of time.
The following are set guidelines for return to play for athletes that have sustained a concussion. These guidelines are compiled from review of multiple sets of guidelines, including those from the American academy of Neurology and the Colorado Academy of Neurology:
- Grade I: 1st concussion - return to play when asymptomatic for 20 minutes; 2nd concussion - return to play when asymptomatic for one week.
- Grade II: 1st concussion - return to play when asymptomatic for one week; 2nd concussion - return to play when asymptomatic for one month.
- Grade III: 1st concussion - immediately transport to hospital for evaluation, return to play one month after injury if asymptomatic for two weeks; 2nd concussion - immediately transport to hospital for evaluation, immediately terminate season.
Anytime a player sustains a concussion, the player should immediately be removed from play and evaluated. The player should be reevaluated frequently, about every 5 minutes until the symptoms of concussion (confusion, dizziness, headache, and unsteady gait) have resolved. If the determination is made that a player should not return to play, it is important to take away an important piece of equipment, such as a helmet or shoe, to prevent the player from reentering play. This is not to say that a coach would willingly send a player with a concussion back in the game. Rather, in large team sports such as football, confusion can exist on the sideline. A player may not remember the concussion or may disagree with the decision and may ask to return, even though they should not. Taking away important equipment from the player simply removes the possibility of them returning to play before it is appropriate, which protects everyone involved, most importantly the player.
Dr. Christopher Munger’s column appears every other Sunday. Dr. Munger is board-certified in family practice. He is a member of the Family Health Care Center in Statesboro and admits patients to East Georgia Regional Medical Center. He is originally from California. He received his bachelors degree from UCLA, his medical degree from Columbia University in New York City and completed his training in family practice at the University of Virginia. He lives in Statesboro with his wife and two dogs.