Returning to play after concussion.

Most agree that organized sports provide a vital source of therapeutic satisfaction for our patients. It is our responsibility to encourage these activities, while also fostering safety and reducing the risk of injury. One such risk, concussion, has always been an inherent danger — one that medical professionals, trainers and equipment designers are still striving to understand. Recent reports of a high incidence of early dementia after repeated head traumas in professional ice hockey and American football players have brought a new immediacy to the problem. These represent some of the more powerful and prominent examples of a topic that the medical community must address at every level of sports. Here are some questions that I have been asked: My son had a concussion in last night’s ice hockey game. How long should he stay out? My daughter was knocked unconscious for just a few seconds in this weekend’s basketball game. She had a CT scan and the emergency room doctor said that everything was okay. Should I be concerned? My son plays football. He’s never had a concussion, but I find that he has become very sensitive to light, and after maintaining an A average for several years, his grades have begun to slip. My doctor says that there is nothing to worry about. Has my son sustained head injury? Concussion, also called minimal traumatic brain injury, has become a prominent issue in the last 10 years (1). Conferences and symposia are now dedicated to addressing the risks of head trauma (2), and the US Centers for Disease Control and Prevention has instituted programmes aimed at reducing the incidence of concussion (3,4). These meetings and hundreds of papers are dedicated to prevention, diagnosis and treatment as well to broadening our understanding of the longand short-term impact of concussion (5).