A neurologist’s main goal is promoting optimal healing after a concussion, but pressure to return athletes to play can make treatment difficult.
Concussion was rarely talked about in neurology as recently as 20 years ago. Now, concussion and post concussive syndrome are becoming well-understood diagnoses with recognizable and identifiable symptoms. Concussion is most often the result of traumatic brain injury, which is quite prevalent in youth and adult sports.
Professional athletes have suffered serious consequences of concussion after retirement from sports, and a number of prominent athletes have spoken publicly about the persistent pain, cognitive impairment, and mood-related sequelae. However, while those of us who are sports spectators shake our heads, quick to judge the whole sports industry’s lack of caution for career players’ brain health, the dangerously blind love of professional and amateur sports is more widespread than critics would like to believe, encompassing all nations and all eras throughout history.
Concussions incurred while playing amateur youth and adult sports, in particular, can be a sticky spot for clinicians. Neurologists are not typically the first physicians to assess a recreational athlete who has experienced a concussion. Neurologists typically pick up the ball on patient care for concerning or persistent concussive symptoms after a sports medicine or pediatric physician has already cared for that patient.
The data regarding return to play shows that the current pattern is far from ideal for most patients, with a study out of Boston reporting that over half of treating clinicians experienced pressure from coaches or players to return athletes prematurely to play. Another peer reviewed article reported that almost 45% of concussion patients returned to school or sports too soon. Neurologists, as the experts in brain health, play an important role in promoting optimal healing after a concussion and in protecting patients from further brain injury.
Education regarding the dangers of concussion during amateur sports has led to systematic changes in the way that schools, coaches, and parents approach sports policy. Pre-concussion baseline testing has become commonplace, particularly in youth contact sports.
Neurologists are central to promoting a disciplined approach to concussion care. Neurologists may be able to avoid being caught up in the excitement of winning and earning scholarships, while at the same time, be resistant to the overreaction, blaming, and unfounded fear that is characteristic of concussion care.
Students do well when they are not unnecessarily relegated to a situation of excessive isolation from the peer environment, resulting in physical, cognitive, and social deconditioning. On the other hand, premature return to work, school, or play has been shown to hinder healing after a concussion.
Concussion treatment is still primarily focused on physical and cognitive rest. There are no effective medical means to repair or speed up brain tissue recovery after a concussion.
Recently, some grading scales quantifying the severity of neurologic function after traumatic brain injury have aided providers in following progress and in determining whether an event caused a clinical injury. The movement towards quantifying guidelines can always be helpful, but good concussion care is dependent on using these tools to support clinical judgment and balancing communication with families and coaches.
Have you ever felt pressured to make a particular recommendation in concussion care?
Carson JD, et al. Premature return to play and return to learn after a sport-related concussion: physician's chart review. Can Fam Phys. 2014 Jun;60(6): e310-e315.
Kroshus E, et al. Pressure on sports medicine clinicians to prematurely return collegiate athletes to play after concussion. J Athl Train. 2015 Sep;50(9):944-951.
McKeon JM, et al. Trends in concussion return-to-play timelines among high school athletes from 2007 through 2009. J Athl Train. 2013 Nov-Dec;48(6):836-843.