Sporting bodies need to update their rules to prevent harmful collisions, according to major new guidelines published today.
A group of more than 100 concussion experts have updated existing recommendations, with the aim of optimising the care of athletes at all levels.
The statement is informed by 10 systematic reviews and methodology outlining the new consensus process and took more than five years to complete.
It is based on the outcomes from the international Conference on Concussion in Sport, which was held in Amsterdam in October last year and is published in today’s British Journal of Sports Medicine
It includes a series of new and updated age-appropriate tools for clinicians and sports organisations to help them better identify and manage sports related concussion and it features new evidence-based strategies for returning to active sport and education after concussion.
It also examines early exercise and treatment recommendations; approaches to prevention; and targeted rehabilitation.
The experts, who are from around the globe, also call for a working group to be set up to guide further research on the potential long-term effects of concussion on health.
Among the key recommendations for prevention of concussion, the statement says rule or policy changes should be introduced to minimise collisions, such as disallowing body checking in ice hockey, while neuromuscular training should be carried out in warm ups.
They also recommend the implementation of laws and protocols, such as mandatory removal from play after actual or suspected concussion; healthcare professional clearance to return to play; and education of coaches, parents, and athletes on the signs and symptoms of concussion.
The experts no longer recommend strict rest as an early intervention. They say there is stronger evidence that light intensity physical activity, such as routine activities of daily living, and aerobic exercise, such as walking and stationary cycling, can aid recovery, as can limiting screen time during the first 48 hours.
Individuals experiencing dizziness, neck pain and/or headaches for more than ten days should undergo cervico-vestibular rehabilitation and any rehabilitation should be targeted to the needs of the individual.
While advanced neuroimaging, biomarkers, genetic tests, and other emerging technologies to assess recovery are useful for research into the diagnosis, outlook, and recovery from sports related concussion, they should not yet be used in clinical practice.
With returning to education and sport, the experts say academic support may be needed for some athletes, which could include modified school attendance, limiting screen time, avoiding any contact sports or game play, extra time to complete assignments/homework or tests.
They recommend light intensity activity in the early phases of the return to sport, with full sports participation usually within one month of injury.
The statement notes the “increasing societal concern about possible problems with later in life brain health in former athletes, such as mental health problems, cognitive impairment and neurological diseases”.
Although there are cohort studies tracking the mental health of people have found that former amateur and professional athletes do not seem to be at heightened risk of depression or suicide later in life, while there is no heightened risk of neurological disease in former amateur athletes.
However, some studies of former professional athletes have reported an association between playing professional American football and professional soccer and neurological disease in later life.
They recommend setting up an interdisciplinary working group to guide appropriate research into the potential long-term effects of concussion on health.
Consensus Statement co-chair Dr Kathryn Schneider, of the University of Calgary, Canada, said: “This Statement sets out a range of new evidence-based recommendations, including those for concussion prevention as well as new versions of the concussion assessment tools and return to sport and school/learning strategies.”
“We encourage clinicians and sports organisations around the globe to adapt these recommendations to their own geographic and cultural environments to optimise the care of athletes who have sustained, or who are at risk of, concussion.”
Professor Jon Patricios of Wits University, Johannesburg, South Africa, Consensus Statement co-chair, added: “The differentiating aspects of this latest Concussion Consensus are the rigorous methodological process we adopted, the new generation of tools available to clinicians, and the emphasis on the positive impact of exercise and targeted rehabilitation as effective interventions. These have the potential to positively change the management of sport-related concussion.”
Patricios J, Schneider K, Dvorak J et al. Consensus statement: Consensus statement on concussion in sport: the Sixth International Conference on Concussion in Sport—Amsterdam October 2022. British Journal of Sports Medicine 15 June 2023; doi 10.1136/bjsports-2023-106898
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