Experts take fresh look at sports concussions
Extended rest may not be best, new treatment ‘road map’ says
TORONTO — An international panel of experts has issued an updated consensus statement on evaluating and treating sports-related concussions that includes some tweaks on managing the brain injury and a discussion on the possible link with chronic traumatic encephalopathy, or CTE.
The goal of the statement is to update doctors, athletic therapists and other healthcare providers on the best way to diagnose a concussion at a sporting event and to manage the patient’s recovery over time.
“Concussion is one of the most complex injuries to diagnose and treat, and our understanding of concussion is constantly evolving,” said panel co-chair Dr. Willem Meeuwisse, leader of the University of Calgary’s Brain Injury Initiative.
“This document attempts to give health-care professionals a road map to what we believe will provide the best patient outcomes.”
The paper is also intended to help advise sports federations — among them those representing hockey, football and soccer — on how to adapt the guidelines to their individual sport. Published in the April issue of the British Journal of Sports Medicine, the statement was penned following a meeting of 32 experts, including several Canadians, in Zurich last November.
One change in the updated version is that an athlete who has suffered a concussion may not always have to rest their brains and bodies as long as previously thought before returning to cognitive and physical activities.
Based on the latest studies, the panel agreed that some of the current treatment protocols — including extended rest — are largely unproven and may not be ideal after the first week following injury.
They suggest that a gradual return to school, social and physical activities is “a sensible approach,” but that athletes should receive medical clearance before returning to competition.
“Typically, we see around 80 per cent of athletes will be recovered within about a week to 10 days,” Meeuwisse said Monday from Calgary.
“What’s changed is, in the past we would say if you’re not better, well ‘get more rest.’ And now we’re recognizing that in the 20 per cent or so who are not recovered by 10 days, that often there are other things that are going on that require a more detailed assessment and often can benefit from rehabilitation.”
After sifting through the latest studies, the panel also confirmed that even the most state-of-the-art helmets and mouth guards do not prevent a concussion, which occurs when the brain is shaken inside the skull.
“While some of the newer technology show a reduction in some of the forces that you can measure in a lab, we’re not seeing any reduction in concussions, which means it’s not probably having the degree of effect on how the brain moves inside the skull, which is really the issue,” Meeuwisse said.
“And some people are concerned that putting more padding on is going to let people hit harder without hurting as much, but yet may have as much or more brain effect.”
Despite all the media attention about the brains of some deceased athletes showing evidence of CTE, the experts say there is not enough evidence to conclude repeated concussions cause the progressively destructive neurological disease. “It’s a recognition that this science is in a very early stage of its development,” Meeuwisse said.