New concussion guidelines: Q&A with a sports medicine physician

thriving concussion mangement

For the last few years, concussions have been on the forefront of the minds of parents, coaches and athletes across the country, as their risks and prevalence become more well-known. This increase in visibility has raised a lot of concern about both the immediate and potential long-term effects of concussions sustained by children and adolescents. Luckily, research efforts have also increased, leading to a better understanding of how concussions should be managed in young athletes.

At the 5th International Conference on Concussion in Sport held in Berlin, Germany, physicians and researchers around the world came together to collaborate on the treatment of sport-related concussions.

One of the outcomes of the conference was a change in the suggested concussion return to play guidelines, a decision that was based on a vast array of research and scientific consensus from multiple institutions, including Boston Children’s.

Dr. William Meehan of Boston Children’s Sports Medicine Division explains what these changes are and how Boston Children’s helped make these advancements possible.

How have the international concussion return to play guidelines changed?

The most significant change was how concussion recovery is managed. Past guidelines have recommended physical rest as well as cognitive rest — such as avoiding schoolwork — until the patient is completely symptom-free. But there has been a substantial amount of research done over the last 4-6 years showing that by engaging in some physical and cognitive activity, your symptoms are likely to go away faster.

So the biggest change is that now we might prescribe 24-48 hours of rest, but then we’d recommended that the patient starts getting back into some level of safe activities, even if they are still having symptoms of a concussion.

How does the Sports Medicine Division at Boston Children’s integrate concussion research into clinical care?

We have published 60 studies on concussions with our collaborators at Boston Children’s in Emergency Medicine, Neurosurgery, Neurology, Neuropsychology, and our colleagues at other institutions. Our physicians and researchers also read the literature regularly, in order to keep informed about what other hospitals are doing. Much of this effort is led by the Brain Injury Center.

Even though these new recommendations were published in April, we changed our own recommendations years ago. We noticed a theme in our own clinics with patients who were exercising in a safe way and participating in cognitive activities: they were getting better faster. Our decision to change our own recommendations back then was based on a variety of research we did within the Sports Concussion Clinic, specifically looking at the benefits of allowing for physical and cognitive activity during recovery.

We also look outside our own hospital and patients and review all current literature, which we then present at two annual conferences — one in the spring that is hospital-wide and includes neurosurgery, neurology, neuropsychology, sports medicine and emergency medicine. The other is in the fall and is run only by Sports Medicine — mostly for the new fellows.

Prior to those conferences, we review all the literature, present it to everyone and then ask, “Should we change our recommendations based on what’s been published?” These are some of the practices that allowed us to change our guidelines long before the international guidelines were changed.

How have the research efforts behind sport-related concussions grown in recent years?

The research has grown tremendously. One of my colleagues posted a paper a few years back that showed all of the research on sport-related concussions published before 2007 was less than the research that had been published between 2007 and 2012. People just largely ignored concussions in the past, but now all of a sudden there has been this major effort put into research — likely due to the recent media buzz around concussions and CTE, especially within the NFL.

We’ve learned a ton, and as a result we manage athletes differently and in a way that likely decreases their risk of having long-term problems from concussions.

Learn more about the Sports Medicine Division at Boston Children’s Hospital