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Return-to-play Guidelines After Concussion: The Message Is Getting Through

Goodman, David PhD; Gaetz, Michael PhD

Clinical Journal of Sport Medicine: September 2002 - Volume 12 - Issue 5 - p 265

School of Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada.

Address correspondence to Dr. David Goodman, School of Kinesiology, Simon Fraser University, Burnaby, BC, V5A 1S6, Canada. E-mail:

The interest in concussion occurring during sport has grown considerably in the past few years. Medical practitioners, sport scientists and other researchers, athletes, and the media have all become more aware of the nature and magnitude of the problems that may follow a concussion. Journals, conferences, and the popular press have addressed this issue with increasing frequency. A review of MEDLINE databases (PubMed) revealed that in the 15 years from 1982 to 1996, only 101 articles addressed the issue of concussion; in the 5 years since, there has been a tripling of the rate of reporting on this important topic. An electronic search using a popular Internet search engine (Google) revealed 28,300 articles using the keywords “concussion” and “hockey”! Although these numbers must be viewed with caution, they serve as a gross indicator of the increasing level of interest regarding concussion in sport.

Major concerns, expressed in several research articles, 1 are the immediate and long-term effects of these injuries. As an awareness of the importance of managing concussion has increased, so has the number of return-to-play guidelines that have been published. 2 Our own experience suggests the significance of these return-to-play guidelines is being felt in at least one amateur sport: hockey. Our data 3 are encouraging.

Beginning in 1998, a 2-year study involving the British Columbia Junior Hockey League (BCHL) examined the problem of concussion in junior hockey. More than 270 players (aged 16–21 years) from 14 teams participated in the investigation, which included a detailed retrospective and prospective player questionnaire. An important element of the questionnaire was a comprehensive history of previous concussion that permitted an analysis of return to play after any such injury experienced from 1995 to 1999. Virtually all players (more than 90%) who were members of a team at the beginning of the season responded by completing the questionnaire. Of those, almost 60% had sustained at least one concussion while playing hockey.

In response to the question “Did you return to the same practice or game (after a concussion)?,” 66% of the players indicated “No” in 1995, but by 1999 the percentage had increased to 83%. This substantial increase in the percentage of players who suffered a concussion of some form and did not return to the practice or game is encouraging. When asked “If you did not return to the same game or practice (after a concussion), when did you return to play?,” the responses indicated that only 25% of the athletes delayed their return beyond 1 week in 1995; by 1999, that figure had increased to 58%. Taken together, the responses indicate that during a 5-year period, there is an indication that junior hockey players are convalescing longer before returning to play after a concussion. The message, it seems, is getting through.

It is difficult to identify one factor as being responsible for this change in athlete behavior. Greater public awareness of the significant problems that can follow concussions, the publicity attached to the career-ending concussions of high-profile players, and changing levels of awareness of coaches, trainers, players, and team staff all played their part in effecting a change in the manner in which concussions were addressed. Participation in a research project designed to improve the assessment of concussion undoubtedly raised the consciousness of many in the league and compelled an examination of return-to-play guidelines. Continual, intensive education of coaches, trainers, and team physicians regarding the appropriate management of concussions will allow this welcome trend to continue.

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1. Meheroz H, Rabadi H, Jordan B. The cumulative effect of repetitive concussion in sport. Clin J Sport Med 2001; 11:194–198.
2. Johnston KM, McCrory P, Mohtadi N, et al. Evidence-based review of sports-related concussion: clinical science. Clin J Sport Med 2001; 11:150–159.
3. Goodman D, Gaetz M, Meichenbaum D. Concussion in hockey: there is cause for concern. Med Sci Sport Exerc 2001; 33:2004–2009.
© 2002 Lippincott Williams & Wilkins, Inc.