Return-to-Play After Concussion: Clinical Guidelines for Young Athletes

2019 ◽  
Vol 119 (12) ◽  
pp. 833
Author(s):  
James A.D. Berry ◽  
Margaret Wacker ◽  
Rosalinda Menoni ◽  
Bailey Zampella ◽  
Gohar Majeed ◽  
...  
Keyword(s):  
Clinical Guidelines ◽  
Return To Play ◽  
Young Athletes

scholarly journals Comparative analysis of state-level concussion legislation and review of current practices in concussion

2012 ◽  
Vol 33 (6) ◽  
pp. E11 ◽  
Author(s):  
Krystal L. Tomei ◽  
Christopher Doe ◽  
Charles J. Prestigiacomo ◽  
Chirag D. Gandhi
Keyword(s):  
Formal Education ◽  
District Of Columbia ◽  
State Level ◽  
Signs And Symptoms ◽  
Washington State ◽  
Return To Play ◽  
Young Athletes ◽  
Evaluation Parameters ◽  
Concussion Education

Object Forty-two states and the District of Columbia have passed legislation based on the Lystedt law of Washington state, enacted in 2009 to protect young athletes who have sustained a concussion. The aim of this study was to note the several similarities and differences among the various laws. Methods Concussion legislation was compared for 50 states and the District of Columbia. Evaluation parameters of this study included stipulations of concussion education, criteria for removal from play, requirements for evaluation and return to play after concussion, and individuals required to assess young athletes. Other parameters that were not consistent across states were also noted. Results Forty-three states and the District of Columbia have passed concussion legislation, and an additional 4 states have pending legislation. All states with existing legislation support concussion education for coaches; however, only 48% require coaches to undergo formal education. Athletes must be educated on concussion in 86% of states and parents in 88.7%. Suspicion of concussion is a criterion for removal from play in 75% of states; signs and symptoms of concussion are criteria for removal from play in 16% of states. The individuals allowed to evaluate and clear an athlete for return to play differ greatly among states. Conclusions Injury prevention legislation holds historical precedent, and given the increasing attention to long-term sequelae of repeated head trauma and concussion, concussion legislation has been rapidly passed in 43 states and the District of Columbia. Although the exact stipulations of these laws vary among states, the overall theme is to increase recognition of concussion in young athletes and ensure that they are appropriately cleared for return to play after concussion.

scholarly journals Return to play with hypertrophic cardiomyopathy: are we moving too fast? A critical review

2021 ◽  
pp. bjsports-2020-102921
Author(s):  
Jonathan A Drezner ◽  
Aneil Malhotra ◽  
Jordan M Prutkin ◽  
Michael Papadakis ◽  
Kimberly G Harmon ◽  
...  
Keyword(s):  
Decision Making ◽  
Hypertrophic Cardiomyopathy ◽  
Shared Decision Making ◽  
Sports Participation ◽  
American Football ◽  
Return To Play ◽  
Medical Decision ◽  
Competitive Sports ◽  
Shared Decision ◽  
Young Athletes

The diagnosis of a potentially lethal cardiovascular disease in a young athlete presents a complex dilemma regarding athlete safety, patient autonomy, team or institutional risk tolerance and medical decision-making. Consensus cardiology recommendations previously supported the ‘blanket’ disqualification of athletes with hypertrophic cardiomyopathy (HCM) from competitive sport. More recently, epidemiological studies examining the relative contribution of HCM as a cause of sudden cardiac death (SCD) in young athletes and reports from small cohorts of older athletes with HCM that continue to exercise have fueled debate whether it is safe to play with HCM. Shared decision-making is endorsed within the sports cardiology community in which athletes can make an informed decision about treatment options and potentially elect to continue competitive sports participation. This review critically examines the available evidence relevant to sports eligibility decisions in young athletes diagnosed with HCM. Histopathologically, HCM presents an unstable myocardial substrate that is vulnerable to ventricular tachyarrhythmias during exercise. Studies support that young age and intense competitive sports are risk factors for SCD in patients with HCM. We provide an estimate of annual mortality based on our understanding of disease prevalence and the incidence of HCM-related SCD in different athlete populations. Adolescent and young adult male athletes and athletes participating in a higher risk sport such as basketball, soccer and American football exhibit a greater risk. This review explores the potential harms and benefits of sports disqualification in athletes with HCM and details the challenges and limitations of shared decision-making when all parties may not agree.

scholarly journals Minimally-Invasive versus Conventional Repair of Spondylolysis in Athletes: A Review of Outcomes and Return to Play

2017 ◽  
Vol 11 (5) ◽  
pp. 832-842 ◽  
Author(s):  
John Paul G. Kolcun ◽  
Lee Onn Chieng ◽  
Karthik Madhavan ◽  
Michael Y. Wang
Keyword(s):  
Quantitative Analysis ◽  
Minimally Invasive ◽  
Current Literature ◽  
Conservative Management ◽  
Literature Search ◽  
Return To Play ◽  
Complication Rates ◽  
Minimally Invasive Procedures ◽  
Invasive Procedures ◽  
Young Athletes

<p>Spondylolysis from pars fracture is a common injury among young athletes, which can limit activity and cause chronic back pain. While current literature has examined the relative benefits of surgical and conservative management of these injuries, no study has yet compared outcomes between conventional direct repair of pars defects and modern minimally invasive procedures. The goals of surgery are pain resolution, return to play at previous levels of activity, and a shorter course of recovery. In this review, the authors have attempted to quantify any differences in outcome between patients treated with conventional or minimally invasive techniques. A literature search was performed of the PubMed database for relevant articles, excluding articles describing conservative management, traumatic injury, or high-grade spondylolisthesis. Articles included for review involved young athletes treated for symptomatic spondylolysis with either conventional or minimally invasive surgery. Two independent reviewers conducted the literature search and judged articles for inclusion. All studies were classified according to the North American Spine Society standards. Of the 116 results of our initial search, 16 articles were included with a total of 150 patients. Due to a paucity of operative details in older studies and inconsistencies in both clinical methods and reporting among most articles, little quantitative analysis was possible. However, patients in the minimally invasive group did have significantly higher rates of pain resolution (<italic>p</italic>&lt;0.001). Short recovery times were also noted in this group. Both groups experienced low complication rates, and the majority of patients returned to previous levels of activity. Surgical repair of spondylolysis in young athletes is a safe and practical therapy. Current literature suggests that while conventional repair remains effective, minimally invasive procedures better clinical outcomes. We await further data to conduct a more thorough quantitative analysis of these techniques.</p>

Nonsteroidal anti-inflammatory drug use and concussions in adolescent athletes: incidence, severity, and recovery

2021 ◽  
Vol 28 (4) ◽  
pp. 476-482
Author(s):  
Zachary Spiera ◽  
Theodore Hannah ◽  
Adam Li ◽  
Nickolas Dreher ◽  
Naoum Fares Marayati ◽  
...  
Keyword(s):  
Head Trauma ◽  
Injury Severity ◽  
Multivariable Analysis ◽  
Return To Play ◽  
Young Athletes ◽  
Adolescent Athletes ◽  
Inflammatory Drug ◽  
Cohort Differences ◽  
Anti Inflammatory ◽  
Concussion Recovery

OBJECTIVE Given concerns about the potential long-term effects of concussion in young athletes, concussion prevention has become a major focus for amateur sports leagues. Athletes have been known to frequently use anti-inflammatory medications to manage injuries, expedite return to play, and treat concussion symptoms. However, the effects of baseline nonsteroidal anti-inflammatory drug (NSAID) use on the susceptibility to head injury and concussion remain unclear. This study aims to assess the effects of preinjury NSAID use on concussion incidence, severity, and recovery in young athletes. METHODS Data from 25,815 ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing) tests were obtained through a research agreement with ImPACT Applications Inc. Subjects ranged in age from 12 to 22 years old. Those who reported NSAID use at baseline were assigned to one (anti-inflammatory [AI]) cohort, whereas all others were assigned to the control (CT) cohort. Differences in head trauma and concussion incidence, severity, and recovery were assessed using chi-square tests, unpaired t-tests, and Kaplan-Meier plots. RESULTS The CT cohort comprised a higher percentage (p < 0.0001) of males (66.30%) than the AI cohort (44.16%) and had a significantly greater portion of athletes who played football (p = 0.004). However, no statistically significant differences were found between the two cohorts in terms of the incidence of head trauma (CT = 0.489, AI = 0.500, p = 0.9219), concussion incidence (CT = 0.175, AI = 0.169, p = 0.7201), injury severity, or median concussion recovery time (CT = 8, AI = 8, p = 0.6416). In a multivariable analysis controlling for baseline differences between the cohorts, no association was found between NSAID use and concussion incidence or severity. CONCLUSIONS In this analysis, the authors found no evidence that preinjury use of NSAIDs affects concussion risk in adolescent athletes. They also found no indication that preinjury NSAID use affects the severity of initial injury presentation or concussion recovery.

scholarly journals Psychological and Social Components of Recovery Following Anterior Cruciate Ligament Reconstruction in Young Athletes: A Narrative Review

2021 ◽  
Vol 18 (17) ◽  
pp. 9267
Author(s):  
Emil Vutescu ◽  
Sebastian Orman ◽  
Edgar Garcia-Lopez ◽  
Justin Lau ◽  
Andrew Gage ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Narrative Review ◽  
Acl Rupture ◽  
Return To Play ◽  
Young Athletes ◽  
Acl Injuries ◽  
Anterior Cruciate

Anterior cruciate ligament (ACL) rupture is a common injury in young athletes. To restore knee stability and function, patients often undergo ACL reconstruction (ACLR). Historically, there has been a focus in this population on the epidemiology of ACL injury, the technical aspects of ACL reconstruction, and post-operative functional outcomes. Although increasingly recognized as an important aspect in recovery, there remains limited literature examining the psychological aspects of post-operative rehabilitation and return to play following youth ACL reconstruction. Despite technical surgical successes and well-designed rehabilitation programs, many athletes never reach their preinjury athletic performance level and some may never return to their primary sport. This suggests that other factors may influence recovery, and indeed this has been documented in the adult literature. In addition to restoration of functional strength and stability, psychological and social factors play an important role in the recovery and overall outcome of ACL injuries in the pediatric population. Factors such as psychological readiness to return-to-play (RTP), motivation, mood disturbance, locus of control, recovery expectations, fear of reinjury, and self-esteem are correlated to the RTP potential of the young athlete. A better understanding of these concepts may help to maximize young patients’ outcomes after ACL reconstruction. The purpose of this article is to perform a narrative review of the current literature addressing psychosocial factors associated with recovery after ACL injury and subsequent reconstruction in young athletes. Our goal is to provide a resource for clinicians treating youth ACL injuries to help identify patients with maladaptive psychological responses after injury and encourage a multidisciplinary approach when treating young athletes with an ACL rupture.

Injuries to the head and cervical spine

2017 ◽  
Author(s):  
Robert V Cantu ◽  
Robert C Cantu
Keyword(s):  
Cervical Spine ◽  
Brain Injuries ◽  
Wide Spectrum ◽  
Signs And Symptoms ◽  
Return To Play ◽  
Spine Injury ◽  
Young Athletes ◽  
Cervical Spine Injuries ◽  
Cord Injury ◽  
Spine Injuries

Traumatic brain and cervical spine injuries in young athletes encompass a wide spectrum, with some injuries occurring in otherwise ‘safe’ sports, and others in high-risk sports where head and cervical spine injuries are the norm. Athletic brain injuries include concussion, intracranial haemorrhage, malignant brain oedema syndrome, and axonal shear. In the cervical spine, injuries include muscle strains, contusions, fractures, or ligamentous disruptions with nerve root or spinal cord injury. Knowledge of these injuries and their signs and symptoms is important for the physician covering a sporting contest or practice. Additionally, preparedness for potential head or cervical spine injury must be addressed by health professionals providing sporting event coverage. This chapter reviews how traumatic brain and cervical spine injuries typically occur in young athletes. It also discusses what the initial treatment of these injuries should entail, along with a discussion of return to play considerations.

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