Barry D. Jordan, MD

The American Academy of Neurology’s position paper on the evaluation and management of sports-related concussion states a belief in the ethical obligation of the treating physician to make sure an athlete is ready to return to play following a concussion and that he or she is educated and protected from what could be a serious neurological injury.

As a practicing sports neurologist for the past 30 years, I agree with the stance that the AAN has taken, and I have found in my own practice that while the injured player and coaches are often anxious for the injured player to get back on the field, it is imperative for the player sit out until he or she has been given the okay by a qualified physician.

In my work with athletes from different sports and of all ages – as an adviser for Pop Warner football up through working on the NFL Players Association Mackey-White Traumatic Brain Injury Committee – the care of the patient has always been and will always be my greatest concern. Contact and collision sports, like football, hockey, and boxing, will never be completely safe, but that doesn’t lessen our responsibility as physicians to shield players from unnecessary injury and to ensure they are well enough to continue the sport.

If a player returns to the game before he is ready, he raises the likelihood of sustaining a second concussion, which is most likely to occur within 10 days of the initial concussion. He also increases his risk of "second-impact syndrome." While this is rare, its effects can be disastrous: traumatic injury and even death has occurred. A concussion is not just a "bump on the head," and everyone involved in a player’s care should take that seriously.

The AAN statement also supports the inclusion of concussion evaluation and training for neurology residency programs. Education on this particular issue is paramount in the fight to keep athletes safe. Making sure that all neurologists have the proper tools and are kept abreast of any changes to concussion management guidelines and testing will continue to ensure players’ safety.

Education for athletes, coaches, athletic trainers, parents, and the community in general also is critical. Once they know and understand the signs and symptoms – and the impact – of a concussion, the easier it will be for everyone to be on board with keeping an athlete out of play until she has been cleared by her doctor. It’s also important to have a better understanding of the scope of the problem and its impact. To that end, the AAN’s idea to create a mandatory national concussion registry is definitely a step in the right direction and could be an integral way to gain a better understanding of the issue at hand.

No matter whether a player has dedicated his life to the sport or if he is in his first Pop Warner season, it will always be tough to tell him that he has to sit out for one or more games. (And, for the younger set, that is often difficult for parents to hear.) But it is the ethical obligation of a physician to make sure a player has no visible signs or symptoms and is cognitively ready to return to play. That, combined with education and knowledge on the subject, as the AAN recommends, will help neurologists and other physicians throughout the country keep players safe and limit the number of concussions and their impact on today’s athletes.

Dr. Jordan is the director of the brain injury program and the memory evaluation treatment service at Burke Rehabilitation Hospital in White Plains, N.Y. He also serves as the assistant medical director there. He currently serves as the chief medical officer of the New York State Athletic Commission, as a team physician for USA Boxing, and as a member of the NFL Players Association Mackey-White Traumatic Brain Injury Committee and the NFL Neuro-Cognitive Disability Committee.

The American Academy of Neurology’s position paper on the evaluation and management of sports-related concussion states a belief in the ethical obligation of the treating physician to make sure an athlete is ready to return to play following a concussion and that he or she is educated and protected from what could be a serious neurological injury.

As a practicing sports neurologist for the past 30 years, I agree with the stance that the AAN has taken, and I have found in my own practice that while the injured player and coaches are often anxious for the injured player to get back on the field, it is imperative for the player sit out until he or she has been given the okay by a qualified physician.

In my work with athletes from different sports and of all ages – as an adviser for Pop Warner football up through working on the NFL Players Association Mackey-White Traumatic Brain Injury Committee – the care of the patient has always been and will always be my greatest concern. Contact and collision sports, like football, hockey, and boxing, will never be completely safe, but that doesn’t lessen our responsibility as physicians to shield players from unnecessary injury and to ensure they are well enough to continue the sport.

If a player returns to the game before he is ready, he raises the likelihood of sustaining a second concussion, which is most likely to occur within 10 days of the initial concussion. He also increases his risk of "second-impact syndrome." While this is rare, its effects can be disastrous: traumatic injury and even death has occurred. A concussion is not just a "bump on the head," and everyone involved in a player’s care should take that seriously.

The AAN statement also supports the inclusion of concussion evaluation and training for neurology residency programs. Education on this particular issue is paramount in the fight to keep athletes safe. Making sure that all neurologists have the proper tools and are kept abreast of any changes to concussion management guidelines and testing will continue to ensure players’ safety.

Education for athletes, coaches, athletic trainers, parents, and the community in general also is critical. Once they know and understand the signs and symptoms – and the impact – of a concussion, the easier it will be for everyone to be on board with keeping an athlete out of play until she has been cleared by her doctor. It’s also important to have a better understanding of the scope of the problem and its impact. To that end, the AAN’s idea to create a mandatory national concussion registry is definitely a step in the right direction and could be an integral way to gain a better understanding of the issue at hand.

No matter whether a player has dedicated his life to the sport or if he is in his first Pop Warner season, it will always be tough to tell him that he has to sit out for one or more games. (And, for the younger set, that is often difficult for parents to hear.) But it is the ethical obligation of a physician to make sure a player has no visible signs or symptoms and is cognitively ready to return to play. That, combined with education and knowledge on the subject, as the AAN recommends, will help neurologists and other physicians throughout the country keep players safe and limit the number of concussions and their impact on today’s athletes.

Dr. Jordan is the director of the brain injury program and the memory evaluation treatment service at Burke Rehabilitation Hospital in White Plains, N.Y. He also serves as the assistant medical director there. He currently serves as the chief medical officer of the New York State Athletic Commission, as a team physician for USA Boxing, and as a member of the NFL Players Association Mackey-White Traumatic Brain Injury Committee and the NFL Neuro-Cognitive Disability Committee.

The American Academy of Neurology’s position paper on the evaluation and management of sports-related concussion states a belief in the ethical obligation of the treating physician to make sure an athlete is ready to return to play following a concussion and that he or she is educated and protected from what could be a serious neurological injury.

As a practicing sports neurologist for the past 30 years, I agree with the stance that the AAN has taken, and I have found in my own practice that while the injured player and coaches are often anxious for the injured player to get back on the field, it is imperative for the player sit out until he or she has been given the okay by a qualified physician.

In my work with athletes from different sports and of all ages – as an adviser for Pop Warner football up through working on the NFL Players Association Mackey-White Traumatic Brain Injury Committee – the care of the patient has always been and will always be my greatest concern. Contact and collision sports, like football, hockey, and boxing, will never be completely safe, but that doesn’t lessen our responsibility as physicians to shield players from unnecessary injury and to ensure they are well enough to continue the sport.

If a player returns to the game before he is ready, he raises the likelihood of sustaining a second concussion, which is most likely to occur within 10 days of the initial concussion. He also increases his risk of "second-impact syndrome." While this is rare, its effects can be disastrous: traumatic injury and even death has occurred. A concussion is not just a "bump on the head," and everyone involved in a player’s care should take that seriously.

The AAN statement also supports the inclusion of concussion evaluation and training for neurology residency programs. Education on this particular issue is paramount in the fight to keep athletes safe. Making sure that all neurologists have the proper tools and are kept abreast of any changes to concussion management guidelines and testing will continue to ensure players’ safety.

Education for athletes, coaches, athletic trainers, parents, and the community in general also is critical. Once they know and understand the signs and symptoms – and the impact – of a concussion, the easier it will be for everyone to be on board with keeping an athlete out of play until she has been cleared by her doctor. It’s also important to have a better understanding of the scope of the problem and its impact. To that end, the AAN’s idea to create a mandatory national concussion registry is definitely a step in the right direction and could be an integral way to gain a better understanding of the issue at hand.

No matter whether a player has dedicated his life to the sport or if he is in his first Pop Warner season, it will always be tough to tell him that he has to sit out for one or more games. (And, for the younger set, that is often difficult for parents to hear.) But it is the ethical obligation of a physician to make sure a player has no visible signs or symptoms and is cognitively ready to return to play. That, combined with education and knowledge on the subject, as the AAN recommends, will help neurologists and other physicians throughout the country keep players safe and limit the number of concussions and their impact on today’s athletes.

Dr. Jordan is the director of the brain injury program and the memory evaluation treatment service at Burke Rehabilitation Hospital in White Plains, N.Y. He also serves as the assistant medical director there. He currently serves as the chief medical officer of the New York State Athletic Commission, as a team physician for USA Boxing, and as a member of the NFL Players Association Mackey-White Traumatic Brain Injury Committee and the NFL Neuro-Cognitive Disability Committee.

Concussions making headlines are no longer only relegated to NFL players and other professional athletes. Recent deaths from sports-related brain injuries among high school football players have shone the spotlight on another vulnerable set of athletes: teenagers and children.

But young football players are not the only ones susceptible to concussions. You can have a concussion in any sport. In fact, studies have shown that female soccer players are especially prone to this injury.

This occurrence was highlighted in a recent study of 351 elite female soccer players aged 11-14 years. Dr. John W. O’Kane of the University of Washington Sports Medicine Clinic in Seattle, and his colleagues found that this group has a higher rate of concussion than has been reported in studies of female soccer players at the high school and college levels. The cumulative concussion incidence in the study was 13% per season or 1.2 concussions per 1,000 athletic exposure hours (JAMA Pediatr. 2014 [doi:10.1001/jamapediatrics.2013.4518]).

©photoaged/FOTOLIA

Further, the study found that 58.6% of symptomatic players continued play and more than half of them (55.9%) were not evaluated by a qualified health care professional.

These findings underline the lack of awareness among athletes this age about the significance of concussions. It also stresses the importance of educating young athletes about the signs of a concussion and reinforcing that it is in their best interest to tell a coach or trainer when they’ve had a concussion. A lot of times, athletes will not tell anyone because they don’t want to be pulled out of the game, but continuing to play puts them at a greater risk.

Concussions need to be properly managed to prevent them from lasting longer than necessary. In the study, those with concussions had symptoms that lasted a median of 4 days. If athletes continue to play on, they are increasing their risk of sustaining another concussion because recurrence is more likely to happen within 10 days of the first concussion.

Additionally, athletes may be predisposing themselves to "second impact syndrome," which is extraordinarily rare, but when it happens, it’s typically catastrophic and may result in traumatic injury or death. Coaches, health care providers, parents, and especially the athletes need to pay attention to the severity and symptoms of the concussions, how long recovery takes, and the time between concussions.

Right now, based on what studies can tell, the biggest risk factor for chronic brain injuries associated with repetitive concussions is exposure. So the longer you play the sport, the higher the risk you have. For these middle school and high school athletes, that is not a significant problem, but there simply hasn’t been a lot of research done on youth athletes.

This recent study plus the Institute of Medicine’s review of sports-related concussion in athletes from elementary school through young adults that began in late 2013 are great first steps in increasing our understanding of the effects of concussion on young players and helping us to figure out the best way to combat this problem.

Dr. Jordan is the director of the brain injury program and the memory evaluation treatment service at Burke Rehabilitation Hospital in White Plains, N.Y. He currently serves as the chief medical officer of the New York State Athletic Commission, as a team physician for USA Boxing, and as a member of the NFL Players Association Mackey-White Traumatic Brain Injury Committee and the NFL Neuro-Cognitive Disability Committee.

Concussions making headlines are no longer only relegated to NFL players and other professional athletes. Recent deaths from sports-related brain injuries among high school football players have shone the spotlight on another vulnerable set of athletes: teenagers and children.

But young football players are not the only ones susceptible to concussions. You can have a concussion in any sport. In fact, studies have shown that female soccer players are especially prone to this injury.

This occurrence was highlighted in a recent study of 351 elite female soccer players aged 11-14 years. Dr. John W. O’Kane of the University of Washington Sports Medicine Clinic in Seattle, and his colleagues found that this group has a higher rate of concussion than has been reported in studies of female soccer players at the high school and college levels. The cumulative concussion incidence in the study was 13% per season or 1.2 concussions per 1,000 athletic exposure hours (JAMA Pediatr. 2014 [doi:10.1001/jamapediatrics.2013.4518]).

©photoaged/FOTOLIA

Further, the study found that 58.6% of symptomatic players continued play and more than half of them (55.9%) were not evaluated by a qualified health care professional.

These findings underline the lack of awareness among athletes this age about the significance of concussions. It also stresses the importance of educating young athletes about the signs of a concussion and reinforcing that it is in their best interest to tell a coach or trainer when they’ve had a concussion. A lot of times, athletes will not tell anyone because they don’t want to be pulled out of the game, but continuing to play puts them at a greater risk.

Concussions need to be properly managed to prevent them from lasting longer than necessary. In the study, those with concussions had symptoms that lasted a median of 4 days. If athletes continue to play on, they are increasing their risk of sustaining another concussion because recurrence is more likely to happen within 10 days of the first concussion.

Additionally, athletes may be predisposing themselves to "second impact syndrome," which is extraordinarily rare, but when it happens, it’s typically catastrophic and may result in traumatic injury or death. Coaches, health care providers, parents, and especially the athletes need to pay attention to the severity and symptoms of the concussions, how long recovery takes, and the time between concussions.

Right now, based on what studies can tell, the biggest risk factor for chronic brain injuries associated with repetitive concussions is exposure. So the longer you play the sport, the higher the risk you have. For these middle school and high school athletes, that is not a significant problem, but there simply hasn’t been a lot of research done on youth athletes.

This recent study plus the Institute of Medicine’s review of sports-related concussion in athletes from elementary school through young adults that began in late 2013 are great first steps in increasing our understanding of the effects of concussion on young players and helping us to figure out the best way to combat this problem.

Dr. Jordan is the director of the brain injury program and the memory evaluation treatment service at Burke Rehabilitation Hospital in White Plains, N.Y. He currently serves as the chief medical officer of the New York State Athletic Commission, as a team physician for USA Boxing, and as a member of the NFL Players Association Mackey-White Traumatic Brain Injury Committee and the NFL Neuro-Cognitive Disability Committee.

Concussions making headlines are no longer only relegated to NFL players and other professional athletes. Recent deaths from sports-related brain injuries among high school football players have shone the spotlight on another vulnerable set of athletes: teenagers and children.

But young football players are not the only ones susceptible to concussions. You can have a concussion in any sport. In fact, studies have shown that female soccer players are especially prone to this injury.

This occurrence was highlighted in a recent study of 351 elite female soccer players aged 11-14 years. Dr. John W. O’Kane of the University of Washington Sports Medicine Clinic in Seattle, and his colleagues found that this group has a higher rate of concussion than has been reported in studies of female soccer players at the high school and college levels. The cumulative concussion incidence in the study was 13% per season or 1.2 concussions per 1,000 athletic exposure hours (JAMA Pediatr. 2014 [doi:10.1001/jamapediatrics.2013.4518]).

©photoaged/FOTOLIA

Further, the study found that 58.6% of symptomatic players continued play and more than half of them (55.9%) were not evaluated by a qualified health care professional.

These findings underline the lack of awareness among athletes this age about the significance of concussions. It also stresses the importance of educating young athletes about the signs of a concussion and reinforcing that it is in their best interest to tell a coach or trainer when they’ve had a concussion. A lot of times, athletes will not tell anyone because they don’t want to be pulled out of the game, but continuing to play puts them at a greater risk.

Concussions need to be properly managed to prevent them from lasting longer than necessary. In the study, those with concussions had symptoms that lasted a median of 4 days. If athletes continue to play on, they are increasing their risk of sustaining another concussion because recurrence is more likely to happen within 10 days of the first concussion.

Additionally, athletes may be predisposing themselves to "second impact syndrome," which is extraordinarily rare, but when it happens, it’s typically catastrophic and may result in traumatic injury or death. Coaches, health care providers, parents, and especially the athletes need to pay attention to the severity and symptoms of the concussions, how long recovery takes, and the time between concussions.

Right now, based on what studies can tell, the biggest risk factor for chronic brain injuries associated with repetitive concussions is exposure. So the longer you play the sport, the higher the risk you have. For these middle school and high school athletes, that is not a significant problem, but there simply hasn’t been a lot of research done on youth athletes.

This recent study plus the Institute of Medicine’s review of sports-related concussion in athletes from elementary school through young adults that began in late 2013 are great first steps in increasing our understanding of the effects of concussion on young players and helping us to figure out the best way to combat this problem.

Dr. Jordan is the director of the brain injury program and the memory evaluation treatment service at Burke Rehabilitation Hospital in White Plains, N.Y. He currently serves as the chief medical officer of the New York State Athletic Commission, as a team physician for USA Boxing, and as a member of the NFL Players Association Mackey-White Traumatic Brain Injury Committee and the NFL Neuro-Cognitive Disability Committee.