Concussion, Recovery and Return to Play Process

Both on a sports field & in clinics, physiotherapists are increasingly tasked with assessing & developing rehabilitation programmes for concussion. Once assumed to be a short-lived transient injury, it is now becoming clear that the effects of concussion (and particularly repeated concussions) likely extend beyond the short term. An increasing body of evidence suggests that following a concussion, athletes possess a higher risk of sustaining both subsequent concussions and musculoskeletal injuries in the medium term. 

Additionally, emerging evidence shows that there may be potential long-term impacts of repeated injuries on cognitive function, mental health and the development of neurological conditions).

Acute Injury Care

The current clinical standard for the management of sports related concussion involves the identification of the signs of concussion, and where appropriate, an on-field triage evaluation to assess the player’s symptoms, orientation and evaluate if any red-flags are present. If a concussion is suspected, the player is removed from play and the on-field assessment is typically followed-up in the medical room with a clinical exam.

As mentioned above, as there are no gold-standard ‘objective’ markers of concussion, this examination is supported by various assessments to evaluate the athletes functional deficits, including clinical symptoms, sensorimotor function (balance, coordination and reaction time) Sports Concussion Assessment Tool (SCAT-5).

Recovery and Return to Play Process 

The traditional model of concussion recovery evaluation is centred around a process called the graduated return-to-play (GRTP) protocol. The GRTP is a phased process whereby after becoming asymptomatic at rest, athletes progress through six-steps which involves the gradual re- introduction of asymptomatic physical and skill-based activities. This means that the return to play of athletes is simply dictated by the length of time since the injury and the athlete reporting no symptoms.

Despite athletes’ symptoms typically resolving within a matter of days, there is a growing body of evidence suggesting that the consequences of  concussion likely extend beyond this "clinical recovery". It is now known with a high level of certainty that athletes who have sustained more than one previous concussion are at a heightened risk of sustaining future concussions). Furthermore, athletes who have sustained a concussion, are more likely to sustain a future musculoskeletal injury following return to play. Emerging evidence has shown that the association may be related to the presence of subtle sensorimotor and neurocognitive deficits which persist beyond the resolution of the traditional signs and symptoms of concussion. What’s more is these defects are not detected by traditional clinical assessment batteries, such as the SCAT5. In other words, disturbances in the way the brain processes its environment and controls the body’s movements likely persist beyond the point at which  an individual notices that obvious symptoms (headaches, dizziness, fatigue etc.) have resolved. 

Over the last few years, research has focused on attempting to understand this relationship and develop clinical tools for the objective evaluation of sensorimotor control, that can be used by the average practitioner and athlete. To do so, inertial sensor technology (such as the Output Sports system) can be used. 

This approach can provide the objectivity and sensitivity of laboratory based systems, while ensuring that the developed tools can be used accessibly across a range of sporting environments.

Learn more about how Output can be an essential tool Sports Physio & Rehab Guide here!