Concussion Management & Return-to-Play Varies Based on Age

The start of this year’s football season brings an increased focus on protecting athletes at all levels from experiencing a concussion. Concussions are much more serious than just “getting your bell rung.” It is a type of traumatic brain injury that occurs when the brain bumps against the skull through an external force such as a linebacker tackling a quarterback or falling from a bicycle.

The force of the impact can cause “tearing or twisting” of neuronal structures in the brain which then causes a breakdown in the normal flow of messages within the brain.

Know the Facts

With more and more children and adolescents participating in organized athletics, it's extremely important for parents and coaches to be educated on how to better be able to recognize the signs and symptoms of a concussion.

Prompt recognition and early initiation of treatment to promote a speedy recovery is key. It is commonly held that if treated correctly “from the get-go” that 80 - 85% of individuals incurring a concussion will be symptom free by 10-14 days and back on the field by 3-4 weeks, or often sooner.

The goal is to return the young athlete back to sports as quickly as possible, but also as safely as possible so as not to put them at increased risk of repeat concussion or more catastrophic injury such as second-impact syndrome.

Results Vary By Individual

Concussion management guidelines and return to play protocols are mandated by several athletic organizations at the professional level on down to the high school and even younger recreational leagues.

It is important to recognize, though, that management of a concussion is not to be done with a “cookie-cutter” approach and past guidelines that used generalized grading systems based upon duration of loss of consciousness or post-traumatic amnesia for example are no longer utilized.

The evaluation, treatment and eventual schedule for return to full activity/athletics for each concussion often varies and needs to be individualized to the concussed athlete. Numerous factors can contribute to the athlete’s course of healing from concussion as well as the duration of time needed to safely return them to play. These include:

• Duration/severity of concussion symptoms
• History of prior concussion(s)
• Pre-morbid history of contributing diagnoses (headaches, learning disabilities, sleep disruption or psychiatric illness)
• The specific sport they are returning to
• The age of the athlete.

Return to academics is another facet of concussion management that should not be overlooked as cognitive stressors (studying, testing, performing work duties, watching TV, playing video games, cell phone use, etc.) can often be just as difficult on the concussed brain as physical stressors such as exercise and athletics – leading to a prolonged course of recovery.

It is commonly accepted that the younger the concussed individual, the longer it often takes for them to recover from a concussion in order to return to contact/collision sports. This is in stark contrast to the increased speed of healing from musculoskeletal injuries such as sprains, strains and fractures experienced in the younger population in comparison to adults.

Due to the varying degrees of brain development during childhood through adolescence and early adulthood, different components of the concussion evaluation may or may not be utilized by the physician seeing your child – dependent upon their age.

The graduated return-to-play schedule progresses in a step-wise fashion from:

1. Light aerobic conditioning 30 minutes/day
2. Full aerobic conditioning and non-contact, sport-specific drills
3. Full non-contact athletic practice and resistance strength training
4. Full contact practice
5. Clearance for full return to contact/collision athletics without restrictions.

It should be noted that the duration of time to full clearance and the duration of time spent at each step of a graduated return to play schedule will often be more conservative, and frequently prolonged the younger the patient.