by Dr. Lisa Brekke

Each year a team of experts meet and discuss updates on prevention, assessment and treatment of concussions. In October of 2022 they met and developed the 6^th International Concussion Consensus which summarizes evidence-based guidelines for concussion prevention, assessment and management. Below I will summarize the 6^th statement with the 8 Rs of Concussions.

Recognize

The new consensus updates the formal definition of concussion to help health care providers properly diagnosis a concussion. The important part for patients and parents to understand is that a concussion is not structural damage to the brain and therefore no abnormalities will be found on imaging. CT scans of the brain may be completed in the ER setting to rule out more serious injury including skull fractures and bleeding.

Reduce

Prevention was a big part of the consensus; finding ways to reduce the occurrence of concussions. The panel unanimously supported the following recommendations:

1. Mouthguard use in child and adolescent ice hockey.
2. Policy disallowing body checking should be supported for all children and most adolescent ice hockey.
3. Strategies limiting contact practice in American football.
4. Neuromuscular training warmup programs are recommended.
5. Policy supporting optimal concussion management strategies to reduce recurrent concussion rates.

Remove

Recognition of concussion is the first step. Removal of player from the field of play should be done if there is a suspicion or actual concussive event. This can be based on players signs and symptoms observed by other players, medical staff, or officials. Players who exhibit signs and symptoms should not return to play or training that day and should be evaluated by an experienced health care provider.

Re-evaluate

Follow-up with a health care provider is warranted after concussion. This is required for athlete to return to play.

Rest and Exercise

Strict rest after concussion is no longer the standard of practice. Relative rest is indicated for the first 48 hours which includes activities of daily living and reduced screen time. After 24-48 hours return to physical activity as tolerated is recommended and should begin with walking. Working with an athletic trainer on site at the school or a physical therapist (preferably one who specializes in concussion management) to return to play is highly recommended.

*It is important to note that in the state of Iowa, return to learn without modifications is required before return to sport can begin. If any delays occur, getting a second opinion and resources to help progress back to play is important.

Refer

Referral to healthcare providers who are specialized in concussion management should be considered for targeted treatment of persisting symptoms.

Rehabilitation

Rehabilitation is recommended post-concussion. In the case of recurrence of symptoms when progressing through return to learn and return to sport strategies, re-evaluation and referral for rehabilitation is recommended.

Recovery

Facilitating return to learn is a vital part of the recovery process for student-athletes. Referral to appropriate health care providers is warranted immediately if there is a delay in return to learn. The return to sport protocol was updated in this consensus. It now includes improved parameters with return to light and moderate aerobic exercise and physician clearance before return to contact to ensure proper recovery to return to play. These guidelines should be utilized by athletic trainers and physical therapists to guide player safely and efficiently back to sport. In the state of Iowa, athletes need to be cleared earlier in the return to sport protocol, before stage 2. This law trumps the new consensus and should be standard practice in Iowa.

In every sports season it is important for individuals to know what to do in the event of a concussion. Persisting symptoms can be debilitating and significantly reduce an individual’s quality of life. Here at Kinetic Edge, we always offer free screens. Please reach out online or call 866-588-0230 to schedule a free screen if you or your child are experiencing concussion symptoms.

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