Posted By: Dev Mishra, M.D., President, Sideline Sports Doc, LLC
A certain prominent NFL quarterback generated quite a bit of publicity a few weeks back as he was cleared for return to play after having sustained his second concussion of the season. The issue of return to play after multiple concussions is tricky and a bit controversial, even for medical specialists such as neurologists and neurosurgeons. Undoubtedly, the issues for this particular quarterback were carefully thought out and discussed with the player and several physicians. He’s been successfully back to play for a few weeks now and will be playing again this weekend in the NFL playoffs, so we’re pulling for him.
The story above is about an adult, a highly paid athlete with access to the best medical evaluation and care possible. So what’s the significance of multiple concussions, especially as it relates to young athletes?
As additional research into concussions in young people shows, there are some emerging facts that need to be carefully considered. Much of the information comes out of the University of Pittsburgh, with three really important points for young athletes:
- Anyone who’s had a concussion has a brain that’s at risk for another concussion with even less impact required to produce the concussion than the first time around
- Girls appear to be more susceptible to concussions and have symptoms that last longer than seen in boys
- Young athletes require less force to cause a concussion than in an adult
The University of Pittsburgh is an internationally-recognized leader in concussion research and I highly recommend their website: http://www.upmc.com/mediarelations/factsheets/pages/concussionsportsmedbg.aspx.
There are many controversial issues with return to play, especially after more than one concussion. If you’re a parent, coach, or injured player these are questions your physician will need to address. We believe the brain has the ability to heal after one concussion, but how long does that take? What types of specific tests should the specialist physician perform to help with the determination of “healing”? Can an athlete who sustains a concussion in a contact or collision sport return sooner to a non-contact sport? What considerations come into play when an athlete has had more than one concussion? Are there a number of concussions after which an athlete must be retired from competition? We don’t have all the answers yet.
As you can see these are complicated issues, and all suspected concussions need to be evaluated by a physician skilled in sports concussion management for return to play. Concussions- whether first time or multiple- are injuries to be taken very seriously. So here are some final points for the young athlete who’s had more than one concussion:
- If you suspect there’s been a concussion- even if the athlete returns to “normal” on the sideline- the young athlete should NOT play again that day, and should be evaluated by a qualified physician skilled in diagnosis and management of sports-related concussion.
- The return to play decision must be in the physician’s judgment and should be in writing.
- You must be fully recovered from the first concussion before return to play. Returning to play before full recovery means the brain has not fully healed, and there is a real risk of a second concussion with less force needed.
- A second concussion needs special evaluation by specialists in brain injury such as neurologists or neurosurgeons. There are some controversial issues with multiple concussions and the expertise of a specialist is valuable.
Stay safe and don’t risk permanent problems with multiple concussions!