The Concussion Protocol

It is not uncommon to read in the sports pages that an NHL or NFL player sustained a concussion and is undergoing the concussion protocol. What is the concussion protocol? There are significant similarities and I will try to explain the big picture of what the protocol means without becoming too technical.

Once a player sustains trauma to the head in either league that is worrisome or suspicious for a concussion the player is removed from the game and taken to a quiet place for evaluation. This will include formal testing of the player and determining any symptoms the player may have. Testing will include cognition, memory and physical tests of balance.

If the player is determined to have sustained a concussion or if there is suspicion of a possible concussion the player is removed from the rest of the game and monitored.

At this point the player may need additional testing or close monitoring. Following the game and the next day the player’s symptoms are monitored. The player is encouraged to avoid activities that might exacerbate symptoms including video games, TV, computer and smart phone activities. As symptoms improve the next steps are taken to determine recovery. When the player’s symptoms have resolved then physical activity can be attempted which typically is a short exercise session of light stationary cycling, jogging or another aerobic activity. If symptoms return then the activity is stopped. If the player tolerates the increase in heart rate without symptoms then in following days the player will continue to slowly increase the activity level and will repeat the neuropsychological testing done previously ---before the season began.

If the neuropsychological testing has returned to baseline and the player has remained without symptoms then they will be allowed to return to practice and increase activity as tolerated. Once their functional skills and conditioning has returned to a level consistent with returning to game action they are released to play. All of this is contingent upon remaining asymptomatic during the progression of activities. As can be seen it can involve several days to protect the health of the player and avoid worsening symptoms or returning them to play prior to resolution of any concussion symptoms.

Frequently associated with concussion can be cervical spine musculature aggravation due to the trauma to the head. Local modalities, stretching and massage can sometimes relieve these symptoms which can be confused with concussion symptoms. Addressing these can help speed recovery and eliminate confusing symptoms.