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Brain & Nervous System Health Center

New Guidelines Raise Safety Bar on Concussions

If head trauma is suspected, health care professional should determine it is safe to return to play, recommendations say
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"But one of the most important things we now know is that until those who have had one concussion are fully recovered they are more likely to have a second concussion," Rosseau said. "The stories we hear that are horrific to every parent and every coach is the child who gets a concussion and goes back to play too soon, and gets a second one with devastating consequences."

Just how devastating it can be was outlined earlier this year in the Journal of Neurosurgery: Pediatrics, which detailed the harrowing double-concussion experience of Indiana high school student Cody Lehe. Resuming football too soon after an initial concussion, Lehe suffered a second concussion. Severe brain injury ensued, leaving Lehe mentally impaired and largely wheelchair-bound.

"When athletes are sent back to play with a concussion, it's because they didn't know they had one or people recognized it but didn't do anything about it," Giza said. "We have to educate trainers, physicians and players so no athlete comes back too quickly or arbitrarily."

To that end, the new guidelines call for trained health professionals to quickly and methodically look for any of the telltale signs of a concussion, including: a headache; light and sound sensitivity; poor balance, coordination and reaction time; speech, sleep or memory disturbances; and, less commonly, a loss of consciousness.

Alongside such symptoms, a custom-tailored recovery plan should take into account a patient's prior concussion history and his or her age. The guideline authors emphasized that younger patients typically need longer recovery periods, and cautioned caregivers to handle patients of high school age and below more conservatively in terms of allowing any return to play.

Across team sports, football (for which well-fitting helmet use is encouraged) was deemed the riskiest activity, alongside rugby. They were trailed overall by hockey and soccer, while the highest risk among girls was pegged to soccer and basketball.

But team sports are just part of the story, Rousseau said.

"The activity that causes the most head injuries is not football," she said. "[It's] not hockey. It's biking. In terms of raw numbers, the biggest group of concussions hitting emergency rooms is cyclists. Nobody is talking about getting rid of bikes. We need to talk about making all sports safer, and that includes individual sports."

The National Football League Players Association, the American Football Coaches Association, the Child Neurology Society, the National Association of Emergency Medical Service Physicians, the National Association of School Psychologists, the National Athletic Trainers Association and the Neurocritical Care Society have all endorsed the new guidelines.

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