The findings of the largest study to be ever done on college athletes have redefined the timeline for recovery from concussion. Previously the normal recovery time was of up to 14 days, which has now been extended up to 28 days.
The findings have been detailed in the journal 'Sports Medicine', in one of the marquee papers to emerge from the NCAA-DoD Concussion Assessment, Research and Education Consortium.
The study's lead researcher, Steve Broglio, director of the University of Michigan Concussion Center, is on the CARE Consortium leadership team and leads the CARE clinical study core.
"Normal return-to-play time was previously set at 14 days — meaning 50 per cent of people recovered in that time. Our paper suggests that 28 days more fully encapsulates the recovery process. At that point, 85 per cent of people have returned to play," Broglio said.
The study found that though median recovery times were consistent with the previously suggested 14 days, it was not until one month post-injury that most athletes were cleared for unrestricted sports participation. This doesn't mean that universities must revise their return to play protocols.
"The RTP protocols are driven by clinical presentation (symptoms), not time, so they don't need to be revised," Broglio said.
Rather, coaches, parents, and athletes should reframe their expectations for return to play, in part to avoid stigmatizing concussed athletes who take longer than 14 days to recover, he said. Reframing the normal recovery time to 28 days helps eliminate unintentional social pressure from teammates, coaches, or parents who hope to see their players back on the field. If a concussed athlete takes longer than 14 days or up to a month, that's completely normal, he said.
There wasn't much variation in recovery times among study subgroups, with various factors altering recovery by only up to two days. The total return-to-play duration was shorter with ADHD medication usage, males, and greater assessment frequency. Those with greater initial post-injury symptom severity, practice/training-related injuries, and three or more prior concussions had longer recoveries.
Concussion management recommendations are outlined every four years by the Concussion in Sport Group, an international body that reviews the medical literature and develops guidelines on clinical care. This paper and others resulting from the CARE Consortium will likely be taken into consideration when the group meets next year, said Broglio, who is also a member of CISG.
Despite increased research in concussion over the previous decade, the trajectory of concussion recovery times across diverse populations of athletes has remained poorly defined, because most sports concussion research centred on male athletes in collision sports, or on female soccer players, Broglio said.
The current study included 34,709 male and female athletes from 30 colleges and universities — more than 1,700 of whom were concussed while participating in 22 sports.
Concussed male athletes most commonly played football (54.7 per cent), soccer (10.7 per cent), basketball (6.8 per cent) and wrestling (6.4 per cent), while concussed female athletes most commonly played soccer (23.4 per cent), volleyball (14 per cent), basketball (12.9 per cent) and lacrosse (8.4 per cent). Broglio said male and female athletes took about the same amount of time to recover from concussions, give or take a day.
Concussion education and treatment have improved dramatically in the last two decades, he said.
"Back when I started in concussion research 20 years ago, we'd manage these injuries with a light switch. We'd ask, 'Do you have symptoms?' and if the answer was no, the athlete was put back on the field. Gone are the days when concussed athletes are put back in the same day," Broglio said.
He added, "Now, we can think of it as a dial, where we slowly progress people back into the sport. Once a player is asymptomatic, it can still take some time. We have to respect the injury and respect the recovery process."
