In last month's column, I defined and explained what a concussion is. Today, I will continue with the different concussion grades.
Dr. Robert Cantu, a noted neurosurgeon and world-renowned expert on concussion, has developed a commonly used grading system.
Cantu defined a Grade I mild concussion as having no loss of consciousness, and post traumatic amnesia/post concussive signs and symptoms that last for less than 30 minutes.
A Grade II Moderate concussion would be, a loss of consciousness for less than a minute or post traumatic amnesia that lasts longer than 30 minutes but less than 24 hours. Also post concussive signs and symptoms greater than 30 minutes but less than seven days.
A Grade III or severe concussion, would be loss of consciousness greater than or equal to one minute or post traumatic amnesia greater than or equal to 24 hours, post concussive signs and symptoms greater than seven days.
These are not absolutes and the return to play decision should always be individualized and not based on a rigid time line, but this is a very good grading system to start with.
This is a very complex subject and one that deserves more than an informational article in the paper, however, it helps to better understand return to play guidelines.
Usually (but not always) the guidelines for return to play in an actual game would be where the athlete has had their first (multiple concussions are a whole different ball game) concussion and the signs and symptoms last less than 20 minutes and completely resolve after 20 minutes Even then, especially with regards to pediatric patients and adolescents, the phrase “when in doubt leave them out” applies. Increasingly, even with high school, college and professional athletes this phrase should apply.
If an athlete had a Grade I concussion near the end of the game or did not go back in or play Cantu recommends that they may return to play if asymptomatic for one week, which is actually the same for a Grade II concussion. The key here is that it is the time that their symptoms completely go away where the time clock for the week off from playing starts. That is most often the part that players, coaches and parents do not understand.
An example would be the player sustains a Grade II concussion in a game on Friday night. On Saturday and Sunday, the player still has a headache, and by Monday morning all signs and symptoms are completely gone. The player is then allowed to gradually (and I stress gradually) increase activities.
First starting from a light walk to a jog, to more strenuous aerobic type activities, then perform more sports specific type activities, then to full contact and then to game play. They have to progress through all these phases being asymptomatic.
If they are not, they have to drop down a level wait a day and progress to next level i.e. if they are symptomatic for a week they should not go back to hitting and playing in a game the day after that week stops.
If they are symptomatic on Saturday and Sunday after a Friday night game, and then become asymptomatic on Monday, they are not going to be able to play that following Friday, but if the athlete remains asymptomatic they would be able to practice and play the following week.
As far as a Grade III concussion, i.e. a severe concussion the athlete should not be allowed to play for at least a month and then after that may return to play if asymptomatic for one week.
These are not absolute or 100 percent guidelines, but I wanted to at least get people an idea on how concussions are treated. There are now programs that allow for baseline testing of an athlete's mental function prior to the season and that makes it easier and provides one piece of the puzzle that may make it easier to decide when an athlete is “back to normal” after a concussion.
These are programs that are routinely used in professional athletics and especially in college. They are becoming more and more commonly utilized in high schools.
I believe they should be utilized in high school, though they are not the only “piece to the puzzle.” There are many different “pieces to the puzzle” to decide when an athlete can go back and play including their history of concussion in the past. Again this subject is much more complicated and lengthy than can be described in one or two newspaper articles, and I have not even touched the subject of the severe long term consequences of repeat concussions. (See Chris Benoit, the Wrestler who recently killed his son, wife and himself).
Concussions are not ankle sprains!
Dr. Marc P. Pietropaoli is a board certified/fellowship trained
orthopedic surgeon/sports medicine specialist and is president of Victory Sports Medicine & Orthopedics in Skaneateles.
Cantu defined a Grade I mild concussion as having no loss of consciousness, and post traumatic amnesia/post concussive signs and symptoms that last for less than 30 minutes.
A Grade II Moderate concussion would be, a loss of consciousness for less than a minute or post traumatic amnesia that lasts longer than 30 minutes but less than 24 hours. Also post concussive signs and symptoms greater than 30 minutes but less than seven days.
A Grade III or severe concussion, would be loss of consciousness greater than or equal to one minute or post traumatic amnesia greater than or equal to 24 hours, post concussive signs and symptoms greater than seven days.
These are not absolutes and the return to play decision should always be individualized and not based on a rigid time line, but this is a very good grading system to start with.
This is a very complex subject and one that deserves more than an informational article in the paper, however, it helps to better understand return to play guidelines.
Usually (but not always) the guidelines for return to play in an actual game would be where the athlete has had their first (multiple concussions are a whole different ball game) concussion and the signs and symptoms last less than 20 minutes and completely resolve after 20 minutes Even then, especially with regards to pediatric patients and adolescents, the phrase “when in doubt leave them out” applies. Increasingly, even with high school, college and professional athletes this phrase should apply.
If an athlete had a Grade I concussion near the end of the game or did not go back in or play Cantu recommends that they may return to play if asymptomatic for one week, which is actually the same for a Grade II concussion. The key here is that it is the time that their symptoms completely go away where the time clock for the week off from playing starts. That is most often the part that players, coaches and parents do not understand.
An example would be the player sustains a Grade II concussion in a game on Friday night. On Saturday and Sunday, the player still has a headache, and by Monday morning all signs and symptoms are completely gone. The player is then allowed to gradually (and I stress gradually) increase activities.
First starting from a light walk to a jog, to more strenuous aerobic type activities, then perform more sports specific type activities, then to full contact and then to game play. They have to progress through all these phases being asymptomatic.
If they are not, they have to drop down a level wait a day and progress to next level i.e. if they are symptomatic for a week they should not go back to hitting and playing in a game the day after that week stops.
If they are symptomatic on Saturday and Sunday after a Friday night game, and then become asymptomatic on Monday, they are not going to be able to play that following Friday, but if the athlete remains asymptomatic they would be able to practice and play the following week.
As far as a Grade III concussion, i.e. a severe concussion the athlete should not be allowed to play for at least a month and then after that may return to play if asymptomatic for one week.
These are not absolute or 100 percent guidelines, but I wanted to at least get people an idea on how concussions are treated. There are now programs that allow for baseline testing of an athlete's mental function prior to the season and that makes it easier and provides one piece of the puzzle that may make it easier to decide when an athlete is “back to normal” after a concussion.
These are programs that are routinely used in professional athletics and especially in college. They are becoming more and more commonly utilized in high schools.
I believe they should be utilized in high school, though they are not the only “piece to the puzzle.” There are many different “pieces to the puzzle” to decide when an athlete can go back and play including their history of concussion in the past. Again this subject is much more complicated and lengthy than can be described in one or two newspaper articles, and I have not even touched the subject of the severe long term consequences of repeat concussions. (See Chris Benoit, the Wrestler who recently killed his son, wife and himself).
Concussions are not ankle sprains!
Dr. Marc P. Pietropaoli is a board certified/fellowship trained
orthopedic surgeon/sports medicine specialist and is president of Victory Sports Medicine & Orthopedics in Skaneateles.
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