Consensus Statement on Concussion in Sport

The 4th International Conference on Concussion in Sport Held in Zurich, November 2012

Paul McCrory, MBBS, PhD; Willem Meeuwisse, MD, PhD; Mark Aubry, MD; Bob Cantu, MD; Jiri Dvorak, MD; Ruben J. Echemendia, PhD; Lars Engebretsen, MD, PhD; Karen Johnston, MD, PhD; Jeffrey S. Kutcher, MD; Martin Raftery, MBBS; Allen Sills, MD; Brian W. Benson, MD, PhD; Gavin A. Davis, MBBS; Richard G. Ellenbogen, MD; Kevin M. Guskiewicz, PhD, ATC; Stanley A. Herring, MD; Grant Iverson, PhD; Barry D. Jordan, MD, MPH; James Kissick MD, CCFP, Dip Sport Med; Michael McCrea, PhD, ABPP; Andrew S McIntosh, MBiomedE, PhD; David L. Maddocks, LLB, PhD; Michael Makdissi, MBBS, PhD; Laura Purcell, MD, FRCPC; Margot Putukian, MD; Michael Turner MBBS; Kathryn Schneider, PT, PhD; Charles H. Tator, MD, PHD

Disclosures

Clin J Sport Med. 2013;23(2):89-117. 

In This Article

Injury Prevention

Protective Equipment—Mouthguards and Helmets

There is no good clinical evidence that currently available protective equipment will prevent concussion, although mouthguards have a definite role in preventing dental and orofacial injury. Biomechanical studies have shown a reduction in impact forces to the brain with the use of head gear and helmets, but these findings have not been translated to show a reduction in concussion incidence. For skiing and snowboarding, there are a number of studies to suggest that helmets provide protection against head and facial injury and hence should be recommended for participants in alpine sports.[115–118] In specific sports such as cycling, motor and equestrian sports, protective helmets may prevent other forms of head injury (eg, skull fracture) that are related to falling on hard surfaces and may be an important injury prevention issue for those sports.[118–130]

Rule Change

Consideration of rule changes to reduce the head injury incidence or severity may be appropriate where a clear-cut mechanism is implicated in a particular sport. An example of this is in football (soccer) where research studies demonstrated that upper limb to head contact in heading contests accounted for approximately 50% of concussions.[131] As noted earlier, rule changes may also be needed in some sports to allow an effective off-field medical assessment to occur without compromising the athlete's welfare, affecting the flow of the game or unduly penalising the player's team. It is important to note that rule enforcement may be a critical aspect of modifying injury risk in these settings, and referees play an important role in this regard.

Risk Compensation

An important consideration in the use of protective equipment is the concept of risk compensation.[132] This is where the use of protective equipment results in behavioural change such as the adoption of more dangerous playing techniques, which can result in a paradoxical increase in injury rates. The degree to which this phenomenon occurs is discussed in more detail in the review published in this supplement of the journal. This may be a matter of particular concern in child and adolescent athletes where the head injury rates are often higher than in adult athletes.[133–135]

Aggression Versus Violence in Sport

The competitive/aggressive nature of sport that makes it fun to play and watch should not be discouraged. However, sporting organisations should be encouraged to address violence that may increase concussion risk.[136,137] Fair play and respect should be supported as key elements of sport.

Knowledge Transfer

As the ability to treat or reduce the effects of concussive injury after the event is minimal, education of athletes, colleagues and the general public is a mainstay of progress in this field. Athletes, referees, administrators, parents, coaches and healthcare providers must be educated regarding the detection of concussion, its clinical features, assessment techniques and principles of safe RTP. Methods to improve education including web-based resources, educational videos and international outreach programmes are important in delivering the message. In addition, concussion working groups, plus the support and endorsement of enlightened sport groups such as Fédération Internationale de Football Association (FIFA), International Olympic Commission (IOC), International Rugby Board (IRB) and International Ice Hockey Federation (IIHF), who initiated this endeavour, have enormous value and must be pursued vigorously. Fair play and respect for opponents are ethical values that should be encouraged in all sports and sporting associations. Similarly, coaches, parents and managers play an important part in ensuring that these values are implemented on the field of play.[58,138–150]

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