Return-to-Play Recommendations for Concussions

The importance of proper healing time after concussion cannot be ignored by parents, coaches or young athletes. Even pros like Boston Bruin Patrice Bergeron know this well.

In my work as an urgent-care pediatrician, I've come to expect resistance from sports parents and young athletes when I make return-to-play recommendations, especially when it comes to concussions.

This is one of the biggest uphill battles we face as pediatricians, but it's one we can't afford to lose without dire consequences for the athlete and family.

For concussions, Boston Bruins Patrice Bergeron's story and his continued cautious, step-wise return to play are the exact playbook we need to follow when handling concussions in athletes of all ages, and is consistent with current recommendations from the American Academy of Pediatrics.

The currently accepted, step-wise return-to-play protocol involves starting with rest and progressing slowly as follows:

- Step 1: No activity with rest

- Step 2: Light aerobic activity

- Step 3: Sport-specific exercise

- Step 4: Noncontact drills; progressive resistance training

- Step 5: Full contact training after medical clearance

- Step 6: Game play

Like with Bergeron, we have to be very cautious with concussions in young athletes and follow a similar plan. Returning to play too quickly and skipping steps can result in catastrophic neurologic events, resulting in permanent issues or death.

In addition, we must recognize that one concussion increases the chance that more concussions will occur. We must recognize that the symptoms of a concussion are variable and can be as obvious as headache and loss of consciousness to as subtle as feeling "out of it" or being moody.

We must be realistic that most athletes fail to report their own symptoms in order to keep playing, putting them in harm's way. And we must be willing to recognize when a player has had too many concussions to continue playing some sports safely. This is where a medical team and neuropsychological testing can be very helpful.

Parents, coaches and athletes need to be educated on this approach if we are to keep our teams truly safe. Everyone needs to be on board with how the system works and why youth sports teams need "disabled lists" just like the pros. For the players, it is imperative that they understand a concussion is a guaranteed, nonnegotiable spot on the DL. They each only have one brain per lifetime; this is the only way to keep that brain safe and healthy during high-risk sports.

Put another way, playing one more game with a concussion is like playing Russian roulette. Is the risk really worth it?

Gwenn Schurgin O'Keeffe, M.D., F.A.A.P., is a pediatrician and mother of two from Wayland, Mass. A graduate of Tufts University School of Medicine, Dr. O'Keeffe completed her residency training at New England Medical Center. O'Keeffe is founder and CEO of Pediatrics Now, www.pediatricsnow.com, and can be reached at ideas@pediatricsnow.com.

author: Gwenn Schurgin O'Keeffe

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