Clinical Review  |   December 2019
Return-to-Play After Concussion: Clinical Guidelines for Young Athletes
Author Notes
  • From the Department of Neurosurgery at Riverside University Health System in Moreno Valley, California (Drs Berry, Wacker, Menoni, Zampella, Majeed, Kashyap, Ghanchi, Elia, Carson, and Miulli); and Western University College of Osteopathic Medicine in Pomona, California (Dr Carson). Dr Berry is a fifth-year resident.  
  • Financial Disclosures: None reported.  
  • Support: None reported.  
  •  *Address correspondence to James A.D. Berry, DO, Department of Neurosurgery, Riverside University Health System, 26520 Cactus Ave, Moreno Valley, CA 92555-3927. Email:
Article Information
Emergency Medicine / Sports Medicine
Clinical Review   |   December 2019
Return-to-Play After Concussion: Clinical Guidelines for Young Athletes
The Journal of the American Osteopathic Association, December 2019, Vol. 119, 833-838. doi:
The Journal of the American Osteopathic Association, December 2019, Vol. 119, 833-838. doi:
The National Center for Injury Prevention and Control at the Centers for Disease Control and Prevention (CDC) identified concussion and mild traumatic brain injury as not only a major public health concern but an epidemic.1 The annual incidence of concussion in the United States is estimated to be as high as 6 per 1000 people or 0.6% of the population.2 Concussion is one of the most commonly encountered conditions in sports medicine. While concussions are certainly not limited to sports, it is an area of intense national focus and debate. There are certain high-mechanism contact sports that have a higher risk of producing concussions, including high-speed collisions in baseball, falls from heights in gymnastics, checking in ice hockey, falling onto hardwood floors in basketball, and head-on collisions in soccer. Perhaps the most damaging sport of all is boxing, during which athletes take repeated blows to the head consistently in every encounter and are declared winners by “knockout,” when the opponent loses consciousness. The mechanism of concussion is not limited to the force of impact but is also influenced by an acceleration/deceleration injury.

Clinical Question: How is a concussion diagnosed and graded? What are the most current clinical guidelines published by authoritative medical societies based on expert consensus? When does the physician treating a young athlete who has just sustained a concussion allow the patient to return to play in competitive sports?

Evidence: The American Academy of Neurologists, the American Osteopathic Association, and other professional medical societies and commissions have all issued official statements about the danger of returning to play too early after an acute concussion or mild traumatic brain injury based on evidence that demonstrates concussions have additive effects, and patients are more vulnerable to secondary injury.

Recommendation: This review of the methods of diagnosing and grading concussion and mild traumatic brain injury and the official return to play guidelines will allow physicians to make the safest medical decisions about when an athlete will return to play to protect the patient from further injury poised by the risk of acute and subacute repetitive head trauma.


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