Concussion protocols,  the procedures used to evaluate and treat concussion, have come a long way from the days of ice packs and aspirin. Modern athletes are bigger, faster, and stronger than ever at collegiate and professional levels. Developing effective concussion protocols to keep pace with the ever-changing game is vital in protecting today’s athletes. The concussion protocols at collegiate and professional levels have improved over the past decade. However, a few additional changes can increase player safety and reduce the incidence of repetitive concussions. 

Contrary to popular belief, concussions are highly personal injuries. Not all concussions are the same, and the “one size fits all” method of treating concussions is a poor approach to concussion management. Exact symptoms, the severity of the concussion, age, and gender must be considered when treating a concussion. Frequently with concussions, medical professionals will subject each patient to standardized testing, recovery parameters, and guidelines. This approach is flawed, as it fails to consider the individual’s unique physical traits and specific treatment requirements. No singular solution exists. Personalized treatment plans are needed to treat specific patients with specific symptoms.

A prerequisite baseline concussion test should be performed for collegiate and professional athletes. It tests memory, balance, concentration, and other cognitive abilities. In the event of a concussion, the post-concussion evaluation results can be compared to baseline values, helping medical personnel better define the injury and develop a recovery program.

One limitation of baseline testing is that it can be easily manipulated; an aggressive coaching staff or athlete can skew baseline data to return an injured player before fully recovering. Players could purposefully underperform on the baseline concussion test, knowing that if they suffered a concussion, they could easily match baseline performance. Since concussions present different symptoms to different athletes, the baseline parameters may not provide specific metrics for all head injuries.

A better approach to identifying cognitive and physical abnormalities in an athlete suffering from a concussion is to “test for what you see.” Testing should be performed to identify losses in ability in areas directly related to the presented symptoms. On a case-by-case basis, a focused examination of the symptoms – slurred speech, loss of balance, headaches, etc.- should be made to more accurately assess the head injury. Testing, diagnosis, and treatment are only as good as the player’s level of cooperation in the process, and a staff’s efforts to identify any abnormal physical and cognitive impairments.

One of the more prevalent issues with concussion management is premature Return-To-Play for athletes. Also known as RTP, this is a step-by-step procedure consisting of physical activity levels an athlete must complete before returning to full-time practice and play. Medical professionals and team staff tend to hyper-focus on completing each physical step, often overlooking the process of cognitive ability evaluation and healing. It takes significantly longer to complete mental restoration than physical restoration, and the injured player faces a higher incidence of repeat concussions by neglecting the cognitive portion of concussion recovery. Research indicates the leading risk factor for long-term health effects from concussions is the time that elapses between concussions. While the number of concussions an athlete suffers is undoubtedly a significant statistic, studies reveal an athlete who suffers concussions in back-to-back weeks is in greater danger than an athlete who suffers the same amount of concussions but over an extended period. Returning to play after a concussion should never be rushed, and the RTP guidelines for athletes suffering repetitive concussions should be closely followed, emphasizing extended recovery and time away from the game.

For many medical professionals and athletes, various questions come to mind regarding concussion treatment and management. Why do some people react differently? Is there a genetic component to concussions? How do different factors affect the recovery? 

All activities have risks, all activities have rewards, it is important for athletes, coaches, parents, and loved ones to carefully weigh the impacts of concussion against a healthy future. By prioritizing money and ego over recovery, athletes are putting their long-term physical and mental health in jeopardy.

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