Since their release eight days ago, the updated Sports Concussion Guidelines issued by the American Academy of Neurology have generated quite the buzz. Every major television network trumpeted the news. Even the Wall Street Journal took interest.
Among concussion specialists, though? Hardly a yawn.
Leave it to the New York Times to get it right, noting, “The move brings the group more in line with best practices followed by the NFL and other leagues and associations.” Those “best practices” have been in place for years. Rather than leading the way, the AAN is following numerous other medical associations and even most state legislatures, including Illinois' and Indiana's.
The last time the AAN issued guidelines was 1997. Those featured a largely cookbook approach based on a concussion grading scale.
“We've moved away from the concussion grading systems we first established in 1997,” Christopher Giza, MD of UCLA, co-lead author of the new guidelines, said in a press release. “(We) are now recommending concussion and return to play be assessed in each athlete individually. There is no set timeline for safe return to play.”
Given the longstanding and overwhelming evidence that grading systems were ineffective — if not downright dangerous — what took the AAN so long?
In 2001, the first International Conference on Concussion in Sport took place in Vienna. In November of last year, the fourth such conference was held in Zurich. Each of the four has issued a consensus statement of guidelines which have evolved according to the most up-to-date research. The most recent statement, not much different from the 2008 version, was published in the British Journal of Sports Medicine six days prior to the publication of the AAN Guidelines.
Not surprisingly, the AAN Guidelines essentially mimic the Zurich Statement. Given the documents share a co-author, athletic trainer, Kevin Guskeiwicz, PhD, ATC of the University of North Carolina, they should be pretty similar.
Regardless of the authoring association, the standards for concussion care are pretty-well established:
Any athlete showing any signs and symptoms of concussion should be removed from play and not allowed to return that day.
The athlete should then be assessed by a health care provider trained in the assessment and management of concussion.
That assessment should include evaluations of symptoms, neurocognitive status — with a test such as ImPACT — and balance.
If diagnosed with a concussion, rest — physical and cognitive — is advised to optimize recovery.
Once the athlete is symptom-free, has neurocognitive scores back to baseline, and normal balance, he or she may be cleared to play. However, that return to play should be in a gradual, step-by-step fashion, that takes a minimum of four days.
Failure to follow these steps invites a second concussion prior to recovery from the first — which can be catastrophic — and/or an unnecessarily prolonged recovery.
John Doherty is a certified athletic trainer and licensed physical therapist. This column reflects solely his opinion. Reach him at firstname.lastname@example.org. Follow him on Twitter @JDohertyATCPT.