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Concussion Bill of Rights #3: Adoption and Enforcement of Conservative Evaluation & Return-to-Play Guidelines

Same-Day Return to Play Should Be Banned

The sad fact, and what makes it sometimes hard for parents to truly believe that programs are taking concussions seriously, is that many of the sports programs in which their children participate do not follow any set of return-to-play guidelines, and if they do follow guidelines, they are too liberal in terms of same-day return-to-play (RTP). When parents are kept in the dark like that, when they have no clue as to how a program treats concussions, their anxiety level naturally goes up. This happened to me when my son Taylor sustained a soccer concussion and his AT told him he only needed to sit out one day.

Thus, the third point in the Concussion Bill of Rights for parents is that the athletic director or administrator, coach, athletic trainer (if there is one) and team doctor have, at the very least, agreed upon and adopted a philosophy for grading and managing concussions before the start of the season which prohibits players who experience concussion signs or symptoms from returning to the same game or practice, and tjhat they use it consistently during the season, regardless of the athlete or circumstances surrounding the injury. In other words, no double standard when it comes to concussions will be applied - one for regular players, one more liberal standard for the "stars."

Same Day RTP Debate

Some advocate against any rule that would flat out bar players who experience concussion signs or symptoms from returning to the same game or practice. They view such a rule as not only unworkable but counter-productive. Their fear is that such a strict, unyielding rule is likely to be evaded by the very players it is designed to protect, leading players to simply stop telling sideline medical personnel that they have any symptoms so as to avoid being benched for the remainder of the game. Many parents, either out of ignorance of the risks or out of a desire to see their child achieve athletic success, adhere to this view as well.

Others, including YouthSportsParents, believe that the rule that best protects our children, is the easiest to apply and the one best supported by the available science, is the one reflected in the consensus statement of the 2nd International Conference on Concussion in Sport held in Prague in 2004: a rule that recommends no return to play for concussed athletes in the same game regardless of how quickly the symptoms appear to clear.

If the penalty for not reporting symptoms, for not playing by the rules, is to be suspended or kicked off the team, then players will not, as some fear, try to evade the rule and adoption will not lead players to simply stop telling sideline medical personnel that they have any symptoms so as to avoid being sidelined for the remainder of the game.

Changing the culture

All of the recent consensus statements recommend such conservative management of concussions in athletes under the age of 18. In the face of such consensus, the only reason I can think of for allowing a youth athlete to return to play in the same game after concussion symptoms clear is because it increases the team's chances of winning. As I write about at length in my book and elsewhere on this website, our youth sports culture has become so obsessed with winning that not only has fun taken a back seat, but, more dangerously, safety as well.

Winning at any level of sports simply isn't worth it, at least when it comes to concussions, which are simply in a league of their own apart from other types of injuries. To the extent our culture teaches that winning is more important for athletes who don't get paid to have their clocks cleaned for a living, it needs to change.

If parents know about the rule in advance, if the reason for the rule is explained before the season begins, I think that, by and large, they will see it as putting their child's safety first, which is exactly as it should be in youth sports.

No excuse

The alleged lack of scientific studies and the amount of clinical judgment involved in concussion management, and the lack of uananimity, either about grading the severity of concussions or in return to play guidelines, while it complicates our efforts to educate parents on concussions, should not be used as an excuse to do nothing.

Conservative management of youth concussions is also necessary, in my view, in order for a program to fulfill the fundamental duty of care— a duty embodied in the United Nations' Conventions on the Rights of the Child adopted by every country in the world with the notable exception of two (Somalia and the United States) — our sports programs, like the rest of adult society, owe every child.



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