National Association of Athletic Trainers

Concussion Management Advice From NATA

Summer is almost here, and that means lots of warm-weather sports activities, and along with it an unfortunate increase in the number of concussions on the youth, high school and college sports playing fields.

"While many parents and athletes think that concussions rarely occur in sports such as lacrosse, soccer, softball and baseball, recent data suggests that concussions occur more frequently than previously thought in these sports," said certified athletic trainer, Kevin Guskiewicz, PhD, ATC, a professor and director of the Sports Medicine Research Laboratory at the University of North Carolina at Chapel Hill.

In recent years, new scientific research and clinical-based literature have given the athletic training and medical professions a wealth of updated information on the treatment of sport-related concussion. To provide athletic trainers, physicians, other medical professionals, parents and coaches with recommendations based on these latest studies, the National Athletic Trainers' Association (NATA) has developed a set of guidelines to prevent and manage sport-related concussion and improve decisions about whether an athlete should or should not return to play after experiencing head trauma.

"The focus on most of the current research is to help eliminate the guesswork involved with treating athletes with concussion," said Guskiewicz. "Considering that more than half of high schools and most youth leagues do not have an athletic trainer on staff to identify and manage injuries on the playing field, it's becoming more difficult to manage this condition.

"It's paramount that parents, coaches and the athletes themselves better understand how to identify a concussion and the initial treatment and care recommendations following a concussion. We hope these guidelines serve to help clinicians more easily implement an effective concussion management plan."

The following is a list of 10 guidelines from the NATA to help prevent and ultimately manage concussions in youth, high school and collegiate settings:

  1. If an athlete shows concussion-like sigs and reports symptoms after a contact to the head, the athlete has, at the very least, sustained a mild concussion and should be treated for a concussion. The terms "ding" and "bell ringer" are discouraged, because they downplay the significance of the injury.

  2. In addition to a thorough clinical evaluation, formal neurocognitive and postural-stability testing (e.g. balance testing to determine that an athlete can stand without changing position) is recommended to assist in objectively determining injury severity and readiness to return to play (RTP). NATA strongly recommends that youth leagues, high schools, colleges and professional teams institute a testing program that incorporates baseline testing of athletes.

  3. Once symptom-free, the athlete should be reassessed to establish that cognition and postural stability have returned to normal for that player. [Editor's note: this is no longer considered the standard of care. Under current guidelines, an athlete must also complete a graduated exercise protocol before being cleared to return to full sports participation].

  4. An athlete with a concussion should be referred to a physician on the day of injury if he or she lost consciousness or experienced amnesia lasting longer than 15 minutes. [Editor's Note: this is completely outdated advice: the current standard of care is that an athlete should be removed from play, not allowed to return, and be referred to a physician if they display or report any signs or symptoms of suspected concussion].

  5. A team approach should be used in making RTP decisions after concussion. This approach should involve input from the athletic trainer, physician, athlete and any referral sources.

  6. Athletes who are symptomatic at rest and after exertion for at least 20 minutes should be disqualified from returning to participation on the day of the injury. [Editor's note: this is no longer considered the standard of care: the current standard is that an athlete exhibiting any signs or symptoms of concussin must be removed from play and not allowed to return, a standard embodied in the laws of all but a handful of U.S. states]

  7. Athletes who experience loss of consciousness or amnesia should be disqualified from participating on the day of the injury. [Editor's note: Again, this is no longer considered the standard of care. LOC is no longer considered a measure of the seriousness of a concussion. It is present in less than 10% of sport-related concussion. The current standard of care is that an athlete exhibiting any signs or symptoms of concussion must be removed from play and barred from returning that day].

  8. Because damage to the maturing brain of a young athlete can be catastrophic younger athletes (under age 18) should be managed more conservatively, using stricter RTP guidelines than those used to manage concussion in the more mature athlete. Therefore, youth athletes are strongly encouraged to never return to play on the same day that a concussion is sustained. [Editor's note: Again, student-athletes suspected of concussion are barred from same-day return-to-play by law in most U.S. states and under the most recent international consensus of concussion experts2]

  9. Any athlete with a concussion should be instructed to rest, but complete bed rest is not recommended. [For more on the need for physical and cognitive rest, click here].

  10. Because of an increased risk for future concussions well as for slowed recovery, athletes with a history of three concussions should be advised that terminating participation in contact sports may be in their best interest. [Editor's Note: most concussion experts believe that there is no set number of concussions an athlete must sustain before a recommendation to retire is appropriate]

Click here for NATA's complete position statement on the management of sport-related concussion.

Source: National Athletic Trainers' Association

1. Guskiewicz KM, Bruce SL, Cantu RC, Ferrara MS, Kelly JP, McCrea M, Putukian M, Valovich McLeod T. National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion. J Athl Tr 2004;39(3):280-297.

2. McCrory P, et al. Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport held in Zurich, November 2012. Br.J. Sports Med 2013: 47:250-258.

Updated and revised May 26, 2013