Terminating a Season after Multiple Concussions

Guidelines to Return to Play and Termination of a Sport Season

Jun 23, 2009

With new research being published about the long term effects of recurrent concussions, the question needs to be asked, "How many is too many?"

There are published research studies establishing a link between recurrent concussion and Chronic Traumatic Encephalopathy (CTI). Chronic traumatic encephalopathy is a degenerative brain disease caused by head trauma. The clinical results of CTI are similar to dementia. However, this disorder can be prevented.

Because recent research undertaken by the Center for the Study of Chronic Traumatic Encephalopathy discovered evidence of the beginnings of brain damage leading to CTI after biopsy results from an 18 year-old athlete with a history of multiple concussions (Dead Athletes' Brains Show Damage From Concussions, January 27, 2009), the difficult question is "how many concussions does it take before permanent brain damage is done"?

Because this answer is yet unknown, parents of young athletes need to be aware of the signs and symptoms of post-concussion syndrome. These are subjective and objective signs that the brain has been concussed and is still suffering from the effects of the initial injury (Dr. Robert Cantu, Journal of Athletic Training, July-September, 2001). These are important to know because the guidelines for return to play and termination of a season are connected to how long post-concussion signs and symptoms last.

Post-concussion Signs and Symptoms Checklist

Post-concussion signs and symptoms should be used as a type of checklist. The signs and symptoms of the athlete should be noted at the time of the initial injury and then recorded every day after the initial injury until all of the symptoms have dissipated. The signs and symptoms may include:

Careful record needs to be kept of the length of the signs and symptoms noted on the above list because the length of the signs and symptoms is linked to return to play and termination of a season guidelines (Dr. Robert Cantu, Journal of Athletic Training, July-September, 2001).

Return to Play and Termination of Season Guidelines

Athletes who sustain an initial concussion with signs and symptoms lasting less than 30 minutes may return to play in one week if they are symptom free at rest and exertion. If the athlete sustains a second concussion with signs and symptoms lasting less than 30 minutes, the return to play time doubles. The athlete may return to play in two weeks if he/she is asymptomatic at rest and during exertion during the previous week. A third concussion should result in termination of the season with the athlete returning to play the following season if asymptomatic.

Athletes who sustain an initial concussion with signs and symptoms lasting more than 30 minutes, but less than 24 hours may return to play in one week if they are symptom free at rest and at exertion. If the athlete sustains a second concussion with the signs and symptoms lasting less than 24 hours, the return to play increases to one month. A third concussion of this magnitude should result in termination of the season.

Athletes who sustain an initial concussion with signs and symptoms lasting more than one week should be out of sport for a least one month. A second concussion of this magnitude should result in termination of the season.

These are general guidelines. Each individual athlete needs to be thoroughly assessed by his/her physician. Athletes sustaining any concussion need to be released by their physician prior to returning to activity.

The copyright of the article Terminating a Season after Multiple Concussions in Sports Medicine is owned by Terry Zeigler. Permission to republish Terminating a Season after Multiple Concussions in print or online must be granted by the author in writing.