Position paper on sports-related concussion sets the right tone

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.