Return to Play Guidelines for Endless Momentum VBC
In accordance with the CDC, NFHS, and the PIAA, Endless Momentum VBC will require a doctor's note clearing an athlete of any injury, and a return to play protocol for a concussion.
This must be signed by a medical doctor or doctor of osteopathic medicine (M.D. or D.O.)
Per Journal article"CONCUSSION" (By Matthew L. Silvis, MD), listed in the PIAA Sport Medicine Guidelines Manual:
Introduction: Concussion is a common injury estimated to affect 1.6-2.3 million athletes per year at all levels of the sport. Previous estimates relied upon loss of consciousness (LOC) as a defining symptom of concussion. We now know that Loss of Consciousness (LOC) occurs in < 10% of all concussions. Abandoning LOC as a part of the definition of concussion has led to a dramatic increase in the number of concussions reported per year.
Definition: The 3rd International Conference on Concussion in Sport defines concussion as a "complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces." Concussion may be caused by a direct or indirect (i.e., force transmitted from the upper body to head) blow. The concussion symptoms are typically short-lived and reflect an underlying functional disturbance to the brain, not structural. Therefore, standard cranial imaging (CT, MRI) is expected in concussion.
Signs and Symptoms: Signs and symptoms of concussion are highly variable and individualized. No two concussions are exactly alike. Some clinicians feel a threshold exists for concussions that vary between individuals, influenced by familial and clinical factors. Concussion signs and symptoms can be categorized as somatic, affective, and cognitive.
| Somatic | Affective | Cognitive |
|---|---|---|
| Headache | Personality changes | Difficulty remembering |
| Fatigue | Emotional disturbances | Loss of consciousness |
| Dizziness | Irritability | Disorientation |
| Balance problems | Sadness | Difficulty concentrating |
| Nausea | Nervousness | Delayed verbal response |
| Vomiting | Delayed motor response | |
| Visual disturbances | Abnormal speech (slurred) | |
| Light sensitivity | Feeling mentally foggy | |
| Sound sensitivity | Grogginess | |
| Sleep difficulties | ||
| Numbness or tingling |
Sideline Evaluation: Sideline evaluation is critical to properly managing an athlete with a concussion. The immediate on-the-field assessment should focus on airway, breathing, and circulation, as well as a focused neurologic assessment (mental status, neurological deficits, and cervical spine status). This assessment determines initial disposition (i.e., whether the athlete needs to be emergently transported to the hospital or further assessed on the sideline). The sideline assessment allows for a more detailed history and exam. The Pocket SCAT2 card can aid a licensed physician of medicine or osteopathic medicine (MD or DO) in this assessment. The history should focus on the mechanism of injury and somatic, affective, and cognitive signs/symptoms. The physical examination should focus extensively on the neurological exam, specifically assessing the mental status and evaluating neurologic deficits. Memory function is best assessed by asking specific sport-related questions (i.e., What venue are we at today? Which half is it now? Who did we play last? What was the score?). Serial exams should occur every 5 minutes until the athlete reaches their baseline.
Guidelines: Concussion should be viewed as present or not, recognizing that the majority will resolve in a short period of time (7-10 days). Complications: Complications of concussion can be quite serious, especially if an athlete returns to play prematurely while still symptomatic. Second impact syndrome is a lethal, poorly understood, rare complication of concussion and occurs when an asymptomatic athlete returns to play and has second head trauma. This "second impact" frequently causes brain swelling and herniation, resulting in death. Far more common is the prolonged recovery noted in post-concussion syndrome. With cumulative concussions, athletes have been noted to have repeat concussions with less impact and prolonged recoveries, sometimes leading to early retirement from contact sports.
Return to Play: An athlete with a diagnosed concussion should not be allowed to return to play on the day of injury. No athlete should return to play until cleared by a licensed physician of medicine or osteopathic medicine (MD or DO) comfortable with current concussion management principles. Return to play after a concussion should not occur until an athlete is asymptomatic, off medications with an unremarkable physical examination and neurocognitive testing (if available).
A stepwise progression is recommended for the following stages and advancing every 48 to 72 hours, beginning with:
1. Light aerobic exercise
2. Sports-specific conditioning
3. Non-contact training drills
4. Full-contact practice
5. Competition
If symptoms recur at any point during this stepwise progression, the athlete should return to the previous level and wait for 24 hours before attempting further advancement. This protocol is individualized frequently depending on the athlete's needs and demands of the sport. A more conservative approach is needed when dealing with young athletes with developing brains (athletes < 18 years of age), as little is known regarding the long-term effects of concussion in this age group.
Prevention: Prevention of concussion in contact sports is limited. The health claims of many products (specialized football helmets, headgear in soccer, custom-designed mouth guards) have limited scientific support and remain an active area of study and not without significant debate in the medical community. Concussion evaluation, management, and prevention are all very active areas of intense research. Athletes, Parents, Coaches, and clinicians should periodically refer to the PIAA Web site for updates.
References: Guskiewicz KM, et al. National Athletic Trainers' Association position statement: management of sport-related concussion. J Athl Train 2004; 39 (3): 280-297. Kissick J, Johnston KM. Return to play after concussion. Clin J Sport Med 2005; 15 (6): 426-431. McCrory P, et al. Consensus statement on concussion in sports: 3rd international conference on concussion in sport held in Zurich, November 2008. Clin J Sport Med 2009; 19: 185-200. McKeag DB, Kutcher JS. Concussion consensus: raising the bar and filling in the gaps. Clin J Sport Med 2009; 19 (5): 343-346. Meehan WP, Bachur RG. Sport-related concussion. Pediatrics 2009; 123: 114-123.
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