Caution necessary with head injuries

The gravity of traumatic brain injury (TBI) in sports cannot be overemphasized. It is among the few ways an athlete can die during a contest.

The responsibility for determining when and if brain-injured athletes can return to full participation in their sports is often the most difficult decision a sports medicine specialist must make. A concussion is the mildest and most frequently encountered form of TBI.

Medical technology offers a vast array of imaging, as well as psychological and electrodiagnostic examinations, as part of the neurological evaluation. Despite the magnitude of the decision to return to play, there is no single test or formula to rely on for guidance.

Before 2008, a rating scale based on the presence or absence of loss of consciousness was used. Unfortunately, the scale was an unreliable indicator of when it was safe to return.

The most dependable approach to this dilemma involves two stages:

• The first is careful analysis of the clinical data, history of the incident and previous TBIs, physical examination and observation. An athlete must be symptom-free, including headaches, dizziness, confusion and visual changes.

Based on this information, it is determined whether an athlete can safely begin a rehabilitation program aimed toward full activity. This decision is best made by a physician experienced in treating athletes.

• The second stage in the recovery process includes returning to activity without symptoms. This procedure begins with a low-impact aerobic exercise for 20-30 minutes, then light resistance training and finally concludes with sport-specific activities performed under observation by a certified athletic trainer.

The rehabilitation process after TBI can take months and, sadly, many outstanding athletes never return to their sports.

Interestingly, it is often the great athletes who take the lessons learned from years of hard work and channel them into immense success in another field of endeavor.