A Review of Return to Play Issues and Sports-Related Concussion

Abstract

Mild traumatic brain injury in sports has become a significant public health concern which has not only received the general public's attention through multiple news media stories involving athletic concussions but has also resulted in local, state, and national legislative efforts to improve recognition and management. The purpose of this article is to review the current literature for return to play (RTP) guidelines. State, regional, national, and professional legislation on sport-related concussion RTP management issues will be reviewed. This article will be helpful in developing a generalized systematic approach to concussion management and highlight specific RTP guidelines. The article will also touch upon specific contraindications to RTP, the role of neuropsychological testing in RTP, and other considerations and complications that affect an athlete's ability to return to competition. Finally, considerations for terminating an athlete's competitive season or ending a career after sustaining a concussion resulting in prolonged and protracted symptomatology or repeated concussions will be reviewed. PubMed and Google were searched using the key terms mentioned below. In addition, the author's library of concussion-related articles was reviewed for the relevant literature.

Return to play management after concussion in football: recommendations for team physicians

“…The management of concussion in football should follow the current international guidelines (Doolan et al, 2012;Finch, McCrory, Ewing, & Sullivan, 2013;Giza et al, 2013;Harmon et al, 2013;McCrory, Meeuwisse, Aubry et al, 2013). …”

“…During the past 20 years different organizations and research groups have developed guidelines and positional statements for the management of concussion in football and other sports (Aubry et al, 2002;Cantu et al, 2006;Casson, Pellman, & Viano, 2009a;Doolan, Day, Maerlender, Goforth, & Gunnar Brolinson, Field, Collins, Lovell, & Maroon, 2003;Giza et al, 2013;Guskiewicz et al, 2004;Harmon et al, 2013;Kirkwood, Yeates, & Wilson, 2006;Lovell & Fazio, 2008;McCrory et al, 2009;McCrory, Meeuwisse, Aubry et al, 2013). West & Marion (2014) have recently compared the current guidelines from the American Medical Society for Sports Medicine (Harmon et al, 2013), the American Academy of Neurology (Giza et al, 2013) .…”

On-field identification and management of concussion in amateur rugby union

“…co.za/content/concussion) before returning to sport. [6,7] This places the injured player at risk of developing long-lasting or permanent symptoms (in extreme cases). [6,8] Thus the unique nature of concussion in rugby, which has been associated with sub-optimal secondary prevention, warrants further investigation into what is considered best practice for onfield identification and management of concussion in amateur rugby union.…”

“Ref, Is This the Final?” Concussion Issues at the 2014 FIFA Men’s World Cup: A Case Study

“…Sport-related concussions have been recognized as a major public health concern of traumatic death and disability on a global basis (Thurman, Alverson, Dunn, Guerrero, & Sniezek, 1999). According to Doolan, Day, Maerlander, Goforth, and Bronlinson (2012) not only are the number of athletes taking part in contact and collision sports worldwide has increase, so has the frequency of sports-related concussions. As a result, the awareness of the long-term impacts and dangers of concussions have greatly increased, thereby becoming a considerable issue (Benson, Meeuwisse, Rizos, Kang, & Burke, 2011;Persky, 2013).…”

“…What were once referred to as "dings," "hits," or many other less ominous-sounding names by athletes are now clearly defined as concussions (Ellenbogen et al, 2010). However, identifying the existence of a concussion is a very challenging part of concussion management since the signs and symptoms can be unclear as every concussion is unique (Doolan et al, 2012;Kissick & Johnston, 2005).…”