By Dev Mishra, M.D.
President, Sideline Sports Doc
Clinical Assistant Professor of Orthopedic Surgery, Stanford University
Most of you are likely familiar with leagues such as the NFL and NBA where athletes with a suspected concussion are required to go through a ‘concussion protocol’. The protocol typically involves a clinical evaluation by a physician skilled in sport concussion management. This would include the physician evaluation, possible sophisticated diagnostics such as neuropsychiatric testing, and a gradual return to play protocol. The gradual return to play protocol exists because sometimes concussion symptoms might not be present at rest but might return with physical exertion. The protocols are designed to give the athlete the best possible chance of safe return to play.
Many of you might not be aware that most state interscholastic (meaning: high school) federations, and several national governing bodies for youth club and recreational sports also have gradual return to play protocols after a concussion. The protocols call for an initial evaluation by a physician knowledgeable in sport concussion, and then a return to play protocol that takes 5 to 7 days for an uncomplicated concussion. This is pretty much the same type of protocol followed by professional sports leagues.
The key part of the equation is seeing the right doctor after a sport concussion. Let’s start off with examples of who not to see. First off, I’m an orthopedic surgeon and team physician, and most of my orthopedic colleagues would not be the right person to see after a concussion because we will usually not be skilled in doing the neurologic testing. We are very knowledgeable in remove from play on the field, and can monitor the return to play protocol, but not good for the detailed evaluation. Next, seeing doctors who have zero knowledge of sports medicine is just a bad idea. We have seen parents who get a clearance note from their next-door neighbor who happens to be a dermatologist. Really? You?d mess with your child’s brain that way? Shame on you parents, and shame on you Dr. Dermatologist. And finally, this may come as a surprise to you but your local pediatrician or family doctor might not be the best choice either, as many of them have no idea of the gradual return to play protocols.
The types of doctors that would be good choices are usually non-surgeons who are specifically trained in sports medicine. These doctors with special qualifications in sports medicine come from a variety of medical specialties such as family practice, internal medicine, emergency medicine, or physical medicine + rehabilitation. An excellent resource to find these sports medicine trained physicians is the American Medical Society for Sports Medicine. On the lower right corner of their home page is a ‘Find A Sports Doc’ search tool. Put in your zip code and a wide enough search radius and you’ll likely find an excellent choice.
In some cases such as multiple concussions, post-concussion syndromes, or other serious conditions it would be best to see neurologists or other concussion specialists at a concussion center. You?ll find these at most major universities that have medical schools.
If you’ve had a concussion I urge you not to cut corners in the return to play process. The cost of a bad decision is simply too high. See the right doctor, make sure to follow his/her instructions closely and give yourself the best chance of a successful recovery from concussion. You only get one brain. Use it wisely.