Using a sledgehammer to crack a walnut: the modern management of concussion

The recent newspaper reports from the USA suggesting the need for legislation to improve the management of sports concussion is to be encouraged, although the scientific basis for these recommendations is probably incorrect and raises a number of disturbing issues.1

How has this situation arisen? There is no doubt that our pathophysiological understanding of sports concussion is incomplete and our management, at best, empirical. Recent expert consensus statements have led to some degree of uniformity of approach and a move away from anecdotal management; however, it is a moot point as to how widespread these consensus views have been adopted by athletes.23

Studies performed in rugby football suggest that, although coaches and parents have a good understanding of the nature and risks of concussion, the athletes themselves seem not to appreciate the potential consequences and, as a result, tend to under-report the injury to medical staff.4 How much of that reflects a lack of athlete-specific education, peer pressure to continue, or simply a function of the immature adolescent brain to understand risk behavior is unclear. Studies from other sports similarly demonstrate this under-reporting bias.5

The risks of concussion are not entirely clear. Given the frequency of the injury in sport and the tendency for athletes to continue to play while symptomatic, it is surprising that problems are not encountered more often. …