Written by Hannah Harp
Spoon Feed
This summarizes current evidence-based care for sports-related concussion and persistent symptoms of concussion. Complete rest is out, and mild-to-moderate aerobic activity is in.
Keep your head up!
Concussion is defined here as a mild TBI incurred during exercise or sport that presents with symptoms within 72 hours of the insult. These injuries commonly resolve within weeks but can persist beyond that time period. Diagnosis is clinical but can be supported by exercise testing where available.
Initial evaluation:
- Immediately, evaluate for red flags indicating intracranial or spinal injury, and take the child out of the game (regardless of symptoms).
- A detailed history of the injury, current symptoms, and past head injuries is followed by a focused physical exam including oculomotor testing, vestibular testing, cervical spine evaluation, orthostatic vital signs, and a general neurological exam.
- The patient should be evaluated by their PCP or a concussion specialist within a few days.
Management:
- Symptoms should be monitored weekly using a validated scale such as the SCOAT6.
- After 24-48 hours of rest, the patient should start a stepwise return-to-school and return-to-play rehabilitation program.
- These programs focus on mild-to-moderate aerobic activity beginning at 50% of age-specific HR maximum, with gradual increases in intensity/HR according to symptoms.
- Cervical muscle pain is a predictor for persistent symptoms and is an indication for PT referral at the first evaluation visit.
- Patients with prominent vestibular symptoms or oculomotor symptoms should be referred to symptom-specific physical therapy.
How will this change my practice?
I love these clinical practice guidelines, especially when it comes to topics that have seen a change in management since I started training. I now have three packets that I give to families after a mild TBI: one educational packet for them, one for their coach, and one for their school. It sets consistent expectations for recovery and when they will be able to return to sports and a full academic load. Families have found these helpful when a coach or teacher has concerns about the child not resting enough, and even in cases where the school requests the child do home-bound teaching for an extended period.
Source
Sport-Related Concussion. N Engl J Med. 2025 Jan 30;392(5):483-493. doi: 10.1056/NEJMcp2400691. PMID: 39879594
