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

Abstract

A concussion is a rare but potentially serious injury of football players. Thus, an immediate and valid diagnosis, estimate of severity and therapeutic management is required. To summarise the published information on management of concussion with respect to a safe return to play (RTP), a literature search was conducted. Current guidelines on concussion in sports and significant studies on concussion in football were analysed. After concussion, management and RTP decision should remain in the area of clinical judgement on an individualised basis according to the current international guidelines. If a concussion is suspected, the player should not be allowed to RTP the same day. The RTP programme should follow a gradual step-wise procedure. A concussed player should not RTP unless he/she is asymptomatic and the neurological and neuropsychological examinations are normal. Untimely RTP bears an increased risk of sustaining another more severe brain injury and repetitive brain injury of long-term sequelae. In football, the management of concussion should primarily follow the recommendations proposed by the Concussion in Sports Group. Information and education of players and their medical and coaching team help to protect the players' health. Future studies on concussion should include validated and detailed information on RTP protocols. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58

Head injuries in children′s football—results from two prospective cohort studies in four European countries

“…The frequency and incidence seem to be in the lower range of previously reported data for adolescent and adult players. 9 Recent data from a retrospective analysis of head injuries in U.S. high schools showed higher incidences as compared to our data. 2 These authors observed 2.8 concussions per 10 000 athlete exposures in boys.…”

“…7,8 As a consequence of the above-mentioned potentially serious sequelae, evidencebased consensus guidelines on the management of concussions and return to training, to competition, to work or to school have recently been developed. [9][10][11][12][13] Children and adolescents represent the largest portion of active football players worldwide. 4,14 Several functional, structural as well as cognitive characteristics differ between the maturing athlete and adults.…”

“…These differences may be relevant with regard to the occurrence and characteristics of head injuries and, particularly, concussions. 9,15,16 For instance, in childhood the head is over-proportionally large relative to the body size and the strength of the neck musculature. The latter may be comparatively under-developed with respect to the impacts that can occur in competitive football.…”

Epidemiology of soccer players traumatic injuries during the 2015 America Cup

“…It is therefore essential to diagnose how serious the concussion is and to avoid later consequences, so the player should only return to the match if this is safe. In cases of cerebral contusion the player should never play again on the same day, even if he has no symptoms and the clinical examination is normal 26 . The knee joint suffers the most severe injuries in soccer, many of which require surgical treatment.…”

Concussion in community Australian football – epidemiological monitoring of the causes and immediate impact on play

“…This has resulted in a general lack of measures that are aimed directly at preventing the occurrence of situations that lead to concussion. Much of the recent literature around concussion has limited its focus to the adoption of management guidelines post-concussion or to the effectiveness of headgear, rather than primary prevention (Hollis et al 2012; Feddermann-Demont et al 2014). Although important, such approaches correspond only to the later-stage levels of countermeasure strategies, outlined by Haddon (Haddon 1973).…”