Article Report

CONCUSSION PROTOCOL FOR RETURN TO PLAY 1

Current Literature Concerning Return to Play for Athletes Post-Concussion

Chlöe Kotzé

Division of Health, Physical Education, and Recreation

College of Education and Human Sciences

Delta State University

PER 611 Current Literature and Trends in Physical Education

Dr. Caroline Fletcher

26 January 2024

CONCUSSION PROTOCOL FOR RETURN TO PLAY 2

Return to play and risk of repeat concussion in collegiate football players: comparative

analysis from the NCAA Concussion Study (1999–2001) and CARE Consortium (2014–

2017)

(McCrea et al., 2020)

Sports-related concussions (SRCs) have gained enhanced awareness over the past 30

years, aiding in the increased number of individuals reporting concussions, as well as the

level of seriousness devoted to abiding by strict protocol for return-to-play (RTP). This study

focused on collegiate-level football players forming part of the NCAA, and suggested that an

initial 7-10 waiting period (at which cerebral vulnerability to enhanced damage is present) for

recovery and zero involvement in the contact sporting environment was necessary to mitigate

the potential risk for adverse neurological events post-SRC. Currently, athletes and coaches

are to adhere to the NCAA’s Concussion Safety Protocol, which considers athlete education

in the preseason, assessment of the athlete pre-participation, diagnoses of concussions, and

injury management post-SRCs to ensure appropriate and safe RTP. Future insights could

adopt a more holistic approach to this, including both subjective and objective assessment

methods for enhanced rehabilitation.

Biomarkers to aid the return to play decision following sports-related concussion: a

systematic review

(Seranatne et al., 2022)

The premature RTP for individuals post-SRC shows increased risks for both

neurological injury and the persistence of the symptoms associated therewith. Due to SRCs

being considered mild traumatic brain injuries (mTBIs), their assessment and compliance

with a suitable clinical protocol prior to the RTP for the respective athlete remains crucial,

with current assessments lacking required objectivity to ensure safe RTP without associated

CONCUSSION PROTOCOL FOR RETURN TO PLAY 3

prolonging of negative neurological effects. With biomarkers aiding in the rehabilitation of

mTBIs, the authors suggest considering the testing of these in accordance with the periodic

phasing of rehabilitation to monitor neurological symptoms that may surpass the

physiological improvements noted visually and via current assessment. For this reason,

biomarkers possess the ability to potentially identify pathological mechanisms and pathways

associated with SRCs, which could refine and improve current assessment and RTP

protocols.

Diagnostic tools for return-to-play decisions in sports-related concussion

(Wellm & Zentgraf, 2023)

This systematic review considered the current literature pertaining to the protocol for

RTP following a SRC and found that despite numerous criteria existing for gradual

progression into competition, these were inadequate in mitigating potential adverse cognitive

and neurological events associated with the condition. As many other physical injuries

(including tendon ruptures and/or torn ligaments) follow a more precise protocol for RTP,

interestingly, SRC protocols are considered less specific and highly subjective in nature, as

well as being placed under heightened pressure to be “resolved” in a timely manner, unlike

their musculoskeletal counterparts. The authors suggest the implementation of specialized

(objective) cognitive assessments concentrating on the individual areas of impairment post-

SRC, the skills required for the specific athlete’s sporting code, and the individual goals of

the athlete to ensure a holistic approach to the traumatic injury is achieved. With 50% of

SRCs going unreported, the need for appropriate assessments and protocols has become an

integral component of rehabilitation, especially considering the enormous economic driving

force behind collegiate and professional sport.

CONCUSSION PROTOCOL FOR RETURN TO PLAY 4

Overview

Current literature regarding RTP protocols for athletes post-SRC remains outdated

due to highly subjective nature of testing methods adopted, as well as the inaccurate reporting

of physiological, neurological, and psychological factors from a coach and athlete standpoint.

For this reason, updated protocols and procedures combining objective and subjective

measures are required, thus reinforcing the need for a more holistic approach in

rehabilitation. In this way, the provision of equal attention and focus to these areas may

produce advances in rehabilitation that are long overdue.

References

McCrea, M., Broglio, S., McAllister, T., Zhou, W., Zhao, S., Katz, B., ... & Guskiewicz, K.

M. (2020). Return to play and risk of repeat concussion in collegiate football players:

comparative analysis from the NCAA Concussion Study (1999–2001) and CARE

Consortium (2014–2017). British journal of sports medicine, 54(2), 102-109.

Senaratne, N., Hunt, A., Sotsman, E., & Grey, M. J. (2022). Biomarkers to aid the return to

play decision following sports-related concussion: a systematic review. Journal of

Concussion, 6, 20597002211070735.

Wellm, D., & Zentgraf, K. (2023). Diagnostic tools for return-to-play decisions in sports-

related concussion. Journal of Concussion, 7, 20597002231183234.

CONCUSSION PROTOCOL FOR RETURN TO PLAY 1

Current Literature Concerning Return to Play for Athletes Post-Concussion

Chlöe Kotzé

Division of Health, Physical Education, and Recreation

College of Education and Human Sciences

Delta State University

PER 611 Current Literature and Trends in Physical Education

Dr. Caroline Fletcher

26 January 2024

CONCUSSION PROTOCOL FOR RETURN TO PLAY 2

Return to play and risk of repeat concussion in collegiate football players: comparative

analysis from the NCAA Concussion Study (1999–2001) and CARE Consortium (2014–

2017)

(McCrea et al., 2020)

Sports-related concussions (SRCs) have gained enhanced awareness over the past 30

years, aiding in the increased number of individuals reporting concussions, as well as the

level of seriousness devoted to abiding by strict protocol for return-to-play (RTP). This study

focused on collegiate-level football players forming part of the NCAA, and suggested that an

initial 7-10 waiting period (at which cerebral vulnerability to enhanced damage is present) for

recovery and zero involvement in the contact sporting environment was necessary to mitigate

the potential risk for adverse neurological events post-SRC. Currently, athletes and coaches

are to adhere to the NCAA’s Concussion Safety Protocol, which considers athlete education

in the preseason, assessment of the athlete pre-participation, diagnoses of concussions, and

injury management post-SRCs to ensure appropriate and safe RTP. Future insights could

adopt a more holistic approach to this, including both subjective and objective assessment

methods for enhanced rehabilitation.

Biomarkers to aid the return to play decision following sports-related concussion: a

systematic review

(Seranatne et al., 2022)

The premature RTP for individuals post-SRC shows increased risks for both

neurological injury and the persistence of the symptoms associated therewith. Due to SRCs

being considered mild traumatic brain injuries (mTBIs), their assessment and compliance

with a suitable clinical protocol prior to the RTP for the respective athlete remains crucial,

with current assessments lacking required objectivity to ensure safe RTP without associated

CONCUSSION PROTOCOL FOR RETURN TO PLAY 3

prolonging of negative neurological effects. With biomarkers aiding in the rehabilitation of

mTBIs, the authors suggest considering the testing of these in accordance with the periodic

phasing of rehabilitation to monitor neurological symptoms that may surpass the

physiological improvements noted visually and via current assessment. For this reason,

biomarkers possess the ability to potentially identify pathological mechanisms and pathways

associated with SRCs, which could refine and improve current assessment and RTP

protocols.

Diagnostic tools for return-to-play decisions in sports-related concussion

(Wellm & Zentgraf, 2023)

This systematic review considered the current literature pertaining to the protocol for

RTP following a SRC and found that despite numerous criteria existing for gradual

progression into competition, these were inadequate in mitigating potential adverse cognitive

and neurological events associated with the condition. As many other physical injuries

(including tendon ruptures and/or torn ligaments) follow a more precise protocol for RTP,

interestingly, SRC protocols are considered less specific and highly subjective in nature, as

well as being placed under heightened pressure to be “resolved” in a timely manner, unlike

their musculoskeletal counterparts. The authors suggest the implementation of specialized

(objective) cognitive assessments concentrating on the individual areas of impairment post-

SRC, the skills required for the specific athlete’s sporting code, and the individual goals of

the athlete to ensure a holistic approach to the traumatic injury is achieved. With 50% of

SRCs going unreported, the need for appropriate assessments and protocols has become an

integral component of rehabilitation, especially considering the enormous economic driving

force behind collegiate and professional sport.

CONCUSSION PROTOCOL FOR RETURN TO PLAY 4

Overview

Current literature regarding RTP protocols for athletes post-SRC remains outdated

due to highly subjective nature of testing methods adopted, as well as the inaccurate reporting

of physiological, neurological, and psychological factors from a coach and athlete standpoint.

For this reason, updated protocols and procedures combining objective and subjective

measures are required, thus reinforcing the need for a more holistic approach in

rehabilitation. In this way, the provision of equal attention and focus to these areas may

produce advances in rehabilitation that are long overdue.

References

McCrea, M., Broglio, S., McAllister, T., Zhou, W., Zhao, S., Katz, B., ... & Guskiewicz, K.

M. (2020). Return to play and risk of repeat concussion in collegiate football players:

comparative analysis from the NCAA Concussion Study (1999–2001) and CARE

Consortium (2014–2017). British journal of sports medicine, 54(2), 102-109.

Senaratne, N., Hunt, A., Sotsman, E., & Grey, M. J. (2022). Biomarkers to aid the return to

play decision following sports-related concussion: a systematic review. Journal of

Concussion, 6, 20597002211070735.

Wellm, D., & Zentgraf, K. (2023). Diagnostic tools for return-to-play decisions in sports-

related concussion. Journal of Concussion, 7, 20597002231183234.