Symptom recovery following concussion: Implications for return to play

British Journal of Sports Medicine. 2004 Oct;


Stump, J., M. W. Collins, M. R. Lovell, J. Norwig, A. Lowe, M. McClincy and F. Fu.



Introduction: Management of sports-related concussion is an area of great interest, particularly regarding recovery and return-to-play decisions. Athletes may not display concussion symptoms or may minimise symptoms. Prematurely cleared athletes risk sustaining cumulative neuropsychological damage or second impact syndrome. Objective: Evaluate the symptom reporting patterns of concussed athletes. Examine cognitive performances of symptom-free athletes 1–3 days post-concussion. Method: In one study, symptoms of concussed athletes having pre-season baseline testing were evaluated 2, 5, 8, and 10 days post-injury. Scores were compared to a control group. In a second study, the symptoms and cognitive function of symptomatic (SC) and asymptomatic concussed (AC) athletes and control athletes were tested. Results: In study one, at 10 days post-injury, the concussed group reported significantly fewer symptoms than at baseline, while symptom reporting in the control group remained relatively stable. In study two, AC and SC groups were more impaired on all ImPACT composite scores (visual memory, verbal memory, visual motor speed, reaction time) versus controls. AC athletes demonstrated higher scores than SC athletes on visual memory, visual motor speed, and reaction time. Conclusions: Return-to-play decisions should not be based entirely on symptom presentation. Neuropsychological test results should also be considered so as not to return a still-concussed athlete back to play.

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