After a concussion, medical clearance required before return to play
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Empowered by new guidelines from the Pennsylvania Interscholastic Athletic Association and the National Federation of High School Associations, game officials beginning this year have been granted a prominent role with any athlete suspected to have a concussion. They are permitted to remove such an athlete immediately from playing in that game.
Most of the time, however, they instead call the potential injury to the attention of that team's certified athletic trainer and/or coach on the sideline, according to coaches, athletic directors, certified athletic trainers and physicians.
"I think everyone is on the same page," said Dr. Michael Cordas, chairman of the PIAA's sports-medicine advisory group.
"I think it has worked," added Dave Tumbas, director of UPMC Sports Medicine's athletic training. "We haven't seen any glaring problems."
With the descending football age groups of the National Football League, the National Collegiate Athletic Association and now high schools adopting such rules for both removal and return to play, Pop Warner youth football joined in line a little more than a week ago.
Pop Warner, serving 280,000 children nationwide, announced Nov. 19 that players and cheerleaders suffering concussions must have a clearance signed by a medical professional trained in the injury before they can return to the field.
Return to play remains a sticking point in the high school and youth levels, where legislation in various states -- a Pennsylvania bill is stalled in the Senate -- often mandates a medical doctor's signature. The PIAA likewise has such a rule on its books, new this year, although it requires the written return-to-play approval of either an M.D. or an osteopathic physician.
"Our belief really is, anytime you bring up that C-word ... that's it, they're done" until deemed healthy by the proper physician, said Dr. Cordas. Not any physician, he added, but someone trained in the identification, treatment and management of this brain injury. "You have to have more than a surface knowledge of concussions. Otherwise you're going to hurt somebody."
Mark Lovell and Michael "Micky" Collins are the director and assistant director of the UPMC Sports Medicine concussion program, experts asked to speak across the world on the subject.
But each has experienced parents who took their child to another medical professional -- in a couple of cases, they said, to a chiropractor and family physician -- to receive a signed clearance for return to play.
"Doctor shopping is certainly something that can happen," said Dr. Collins. "What's amazing is when a parent hears what's going on and [the child] can't go back to play ... they still take their kid [elsewhere] to be cleared. That's a little bit scary. I've seen some cases of that -- not many, one or two already this year."
West Allegheny High athletic director Dave McBain, an athletic trainer for nearly 25 years, recalled one athlete signing his doctor's name on a return-to-play form.
"How did I know?" Mr. McBain explained. "One, it was spelled out Dr. So-and-so, not So-and-so M.D. Two, it was written in pencil. Needless to say, the kid -- and his pants -- barely made it to the locker room to put his street clothes back on after I chewed him out."
First Published November 28, 2010 12:00 am