AMSSM: All Symptoms from Concussions Must Be Gone Before Returning to Play

Athletes with concussions must be held out of practice or play until all symptoms have resolved, to avoid the risk of further injury during the vulnerable period before the brain has recovered, according to a new American Medical Society for Sports Medicine (AMSSM) position statement on concussions in sport publicized in the January issue of Clinical Journal of Sport Medicine.

The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

The position statement, which was prepared by a task force of the AMSSM, a professional organization representing more than 2,100 nonsurgical sports medicine physicians, “provides an evidence-based, best practices summary to assist physicians with the evaluation and management of sports concussion.”

“This statement is really a comprehensive guide to the current knowledge on concussion,” said lead author Dr Kimberly G. Harmon of the University of Washington, Seattle. “It is critically important that sport concussions be evaluated and managed by medical professionals who are trained and familiar with sport concussion and aware of strengths and limitations of tests used to evaluate them.”

The AMSSM statement is available on the journal website —

While defining concussion as a “subset of mild traumatic brain injury…at the less severe end of the brain injury spectrum,” the AMSSM went on to note that “the injury generally resolves completely with time. However, a growing body of research finds that concussion is followed by a period of increased vulnerability to repeat injury. Sustaining another concussion during this time has been linked to worse outcomes. In athletes and others with repeated concussions, irreversible damage may occur.”

The AMSSM statement further emphasizes that “there is no same day return to play for an athlete diagnosed with concussion.”  It “supports the use of checklists for assessing concussion symptoms and tracking them over time. Computerized neuropsychological tests can be useful if performed by experts, but are not necessary for most athletes with concussions.”

Ultimately, “symptoms should be completely resolved before the athlete resumes exercise or practice. Return to play should be gradual, with step-wise increases in physical demands, sport-specific activities, and risk of contact.”

While agreeing that “modification and enforcement of the rules and fair play may help” in preventing concussions, there “is no evidence that equipment, including helmets or mouth guards, reduces concussion risk.”

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