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JOHN DOHERTY: Concussion consensus follows a new set of 'reminders'
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JOHN DOHERTY: Concussion consensus follows a new set of 'reminders'

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The current issue of Forbes magazine includes an article entitled, “Top Worries of Football BCS Athletic Directors is Sobering and Sadly Realistic.”

Subtitled, “One Phone Call From Disaster,” the piece lists the top 10 concerns of a former Division I athletic director. Number one, not surprisingly, is financial sustainability. In fact, the next nine tie directly into number one.

Number two is, “No stopping the football and men’s basketball arms races.”

One might imagine that coach or athlete misbehavior would be next — and it does make the list at number 10. However, number three reads, “The cost of concussion lawsuits is an approaching freight train.”

Late last month, the British Journal of Sports Medicine published the “Consensus Statement on Concussion in Sport — the 5th International Conference on Concussion in Sport Held in Berlin, October 2016.”

College athletic directors, who insist that their medical and coaching staffs follow the consensus statement guidelines, should see their concussion-related financial concerns largely fade with time.

Ditto for administrators at the high school and professional levels.

Mimicking the three "Rs" of elementary education — reading, ‘riting, and ‘rithmetic — the authors of the statement came up with 11 of their own when it comes to managing concussion: recognize, remove, re-evaluate, rest, rehabilitation, refer, recover, return to sport, reconsider, residual effects and risk reduction.

The key to recognizing sports related concussion (SRC), according to the statement is understanding that, “SRC may be caused by either a direct blow to the head, face, neck or elsewhere on the body with an impulsive force transmitted to the head. SRC typically results in the rapid onset of short-lived impairment of neurological function that resolves spontaneously.”

Those neurological impairments include headache, nausea and vomiting, dizziness, loss of balance, confusion, light and noise sensitivity, memory loss, exaggerated or inappropriate emotions, and — very rarely — loss of consciousness.

Once SRC is recognized, the athlete must be removed from game or practice and, per the statement, “not be left alone after the injury, and serial monitoring for deterioration is essential over the initial few hours after injury.”

Re-evaluation should take place in an emergency room, if necessary, or, more commonly, in a doctor’s office a day or two later. That physician’s exam should include a “detailed neurologic examination, including a thorough assessment of mental status, cognitive functioning, sleep/wake disturbance, (eye) function, (inner ear) function, (walking) and balance.”

Rest is part of recovery but it should be relative not total rest. Approximately 24-48 hours postinjury, “patients can be encouraged to become gradually and progressively more active while staying below their cognitive and physical-symptom-exacerbation thresholds.”

Rehabilitation may be necessary to address prolonged psychological, neck-related, and/or balance problems.

Referral to a concussion specialist is advised when symptoms persist beyond 10-14 days in adults and four weeks in children.

Recovery is controversial and the authors admit that clinical recovery (when all signs and symptoms are gone) may occur faster than recovery at the cellular level in the brain. Furthermore, they are concerned that recent literature indicates “that a sizable minority of youth, high school, and collegiate athletes take much longer than 10 days to clinically recover.”

Return to sport, as with the previous four statements, should be gradual but instead of being as quick as 4-5 days, this statement recommends a minimum of one week following the complete resolution of symptoms at rest.

Next week, the three remaining ‘R’s.

John Doherty is a licensed athletic trainer and physical therapist. This column reflects solely his opinion. Reach him at jdoherty@comhs.org. Follow him on Twitter @JDohertyATCPT.

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