Consider the following scenarios:

Scenario 1: Your football-playing son tells you he blacked out briefly during a game after making a hard tackle. He sits out practice for the next couple of days during which he has headaches and can't remember what happened either before the game or after. Is it okay for him to play in the next game?"

According to the three most widely used guidelines, the answer is no for Scenario 1, yes for Scenario 2, and no for Scenario 3.

The player in Scenario 1 has suffered a Grade 3 (severe) concussion because, under the Colorado Medical Society (Colorado) and American Academy of Neurology (AAN) guidelines, any loss of consciousness, however, brief is considered a severe concussion, while, under the most widely followed guidelines issued by Dr. Robert C. Cantu (Cantu), the concussion is a Grade 3 because of the loss of consciousness and post-traumatic amnesia (PTA) that had persisted for more than 24 hours. When he can return, however, will vary, depending on the guidelines. Under the Colorado guidelines, he will need to sit out at least a month, and only be permitted to play again after going 2 full weeks without symptoms. Under the AAN guidelines, he must be symptom free for a week before returning to sports. Since he continued to have PTA for several days, he needs to wait until a week after his memory returns before he can resume practicing or playing in games. Under the Cantu guidelines, he will also have to sit out one month and may only return to play then if he has been symptom-free for a week.

The player in Scenario 2 has sustained a Grade 2 (moderate) concussion under all three guidelines. Because he has been symptom-free for one week, he may begin playing again.

The player in Scenario 3 has sustained a Grade 1 (mild) concussion under all three guidelines - no loss of consciousness, clear of symptoms within 15 minutes (AAN), 30 minutes (Cantu) and symptom-free for 20 minutes before returning (Colorado) - followed by a Grade 2 (moderate) concussion. According to the Cantu and Colorado guidelines, anyone suffering a Grade 2 concussion after a Grade 1 concussion should sit out for a minimum of a month, returning at that point only if he or she has been symptom-free for at least a week. Indeed, both call for considering the possibility of ending the season at that point. The AAN approach is less conservative in this situation. It calls for a return to play after two symptom-free weeks, although, it suggests an early termination to the season in the event a CT or MRI disclosed any abnormalities.

Dr. Robert Cantu, Chief of Neurosurgery at Emerson Hospital in Concord, Massachusetts and MomsTeam expert, is concerned that many athletes and their parents don’t understand the risk of playing "while still symptomatic from an initial head injury." Coaches, especially in sports with the highest-risk of head and neck injury, may not "fully understand the risk," says Cantu, because many of them are not certified in first-aid.

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Article Updated: August 1, 2007

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Head & Neck Injuries By Sport (1982 to 1997)
Concussions: What To Look For
Guidelines For Return To Sports Activities After Suffering A Concussion

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