Governing bodies across all sports — many perhaps prompted by increased awareness and liability — have adopted official policies and protocols to deal with concussions and protect themselves from possible legal action.
Many organizations’ protocols reference materials from two initiatives: the Centers for Disease Control and Prevention’s HEADS UP Concussion in Youth Sports and the Consensus Statement on Concussion in Sport by the International Conference on Concussion in Sport.
Through HEADS UP, the CDC provides free online concussion training and information for coaches, parents, sports officials, and athletes. It also features the “6-Step Return to Play Progression,” which advises a return to regular activities (school) as the first step, and then a gradual increase of activity, from light aerobic activity all the way back to full competition.
The latest version of the Consensus Statement on Concussion in Sport written by the Concussion in Sport Group was published in the British Journal of Sports Medicine in April 2017, but the CISG has met a total of five times, the first in 2001.
All 50 states and the District of Columbia also have laws on concussions in sports for youth and/or high school athletes. The individual laws vary, but most require information and education to be given to coaches, athletes, and parents; the removal from play of an athlete suspected to have sustained a concussion; and permission from a healthcare professional to return to play.
What follows are the details of individual governing bodies and organizations’ concussion policies and protocols. We contacted and researched the FIVB and were unable to come up with its policy.
NCAA: Before 2010, the NCAA did not have any guidelines relating to brain injury. After settling a class-action lawsuit in 2014 by providing $70 million for concussion testing and diagnosis, the NCAA began requiring schools to have personnel trained to handle concussions at contact-sports games. That year, the NCAA also launched a $30 million concussion study co-funded by the U.S. Defense Department.
Starting in 2015, every member institution in the power-five conferences (ACC, Big Ten, Big 12, SEC, Pac-12) is required to write and submit a concussion safety protocol to the NCAA’s Concussion Safety Protocol Committee each year. Schools outside of the power five have the option to write a concussion safety protocol and have it reviewed by the NCAA.
The individual school’s protocols must be consistent with the NCAA Sport Science Institute’s Interassociation Consensus: Diagnosis and Management of Sport-Related Concussion Best Practices. However, according to a 2017 ESPN article, the NCAA has never disciplined a school for not filing its concussion plan or not following the protocols contained in those plans.
The key points of SSI’s best practices are similar to the provisions included in many state laws governing high school sports: educational materials must be handed out to student-athletes, coaches, team physicians, athletic trainer, and athletic directors annually; athletes must do baseline concussion testing; athletes experiencing signs or symptoms of a concussion must be removed from practice or competition and sent to the athletic trainer or team physician; and return-to-play protocol must be followed.
The return-to-play protocol isn’t so straightforward, however. The NCAA’s recommendations reflect the gaps in the scientific community’s understanding of concussion and the need for an individualized approach to return-to-play. The guidelines even note, “a symptom-free waiting period is not predictive of either clinical recovery or risk of a repeat concussion.”
The basic steps after an athlete returns to baseline are as follows, with the athlete moving to the next step only when they can complete the current step without experiencing symptoms:
- Light aerobic exercise.
- Sport-specific activity without head impact.
- Non-contact sport drills and progressive resistance training.
- Unrestricted training.
- Return to competition with medical clearance.
The best practices also includes return-to-academics guidelines, stating that athletes should avoid the classroom on the same day of the concussion, and then return in graduated increments once he or she can tolerate cognitive activity without the return of symptoms.
USA Volleyball: Citing the difficulty of developing a policy that conforms to each state’s individual law, USA Volleyball does not have an official concussion protocol.
Instead, a representative of USA Volleyball directed VolleyballMag.com to its Health and Safety web page, where it has gathered a number of facts, resources and links for USAV coaches and players, including many materials from the CDC’s HEADS UP program.
The page also includes information about the Lystedt Law, which was passed in the state of Washington in 2009. Since then, all 50 states the District of Columbia have passed some sort of concussion legislation, but USAV’s Health and Safety website does not include information about any of the laws in states other than Washington.
This page also includes Risk Manager Notices and statements regarding prevention of sexual abuse and developing a safe strength and conditioning program, as well as a link to the United States Anti-Doping Agency website. Links to NFHS free courses, including one on concussion in sport are listed at the bottom of the page.
Amateur Athletic Union: The AAU’s concussion policy is short and straightforward. The meat of it is as follows:
“Where there is reasonable cause to believe that a concussion may have occurred, such participant shall not be allowed to continue his/her participation in an AAU licensed event/activity without a medical release to resume such participation.
The AAU recommends all of its coaches, and other non-athlete members working with youth athletes avail themselves to the Center for Disease Control’s (CDC) Heads Up program.”
The AAU also mandates training courses on concussion safety for all football and hockey coaches and their event directors.
JVA: “JVA is not a governing body, but as a trade association to provide resources for clubs, we do share the State of Ohio concussion video presentation with our members,” executive director Jenny Hahn said in an email.
This fall, the JVA is also planning a webinar series on risk management, addressing safe surroundings, first-aid training and responding to common injuries, including concussions.
NFHS: The National Federation of State High School Associations (NFHS) provides a set of concussion guidelines, as well as an online concussion course for coaches. The NFHS has also suggested specific changes to high school football in order to limit head injuries.
The guidelines list the common signs and symptoms of concussion and emphasize “when in doubt, sit them out.” They also reference the four-step action plan laid out by the CDC’s HEADS UP initiative:
1. Remove the athlete from play.
2. Ensure the athlete is evaluated by an appropriate health-care professional.
3. Inform the athlete’s parents/guardians about the possible concussion and give them information on concussion.
4. Keep the athlete out of play the day of the injury, and until an appropriate health-care professional says the athlete is symptom-free and gives the OK to return to activity.
It is important to note that the NFHS is an association, not a governing body, and therefore can only provide recommendations to its various member organizations.
NBA: In addition to education and baseline testing, the NBA’s concussion policy requires an immediate evaluation if a player is suspected to have sustained a concussion, and then a follow-up evaluation approximately 24 hours later, or prior to the team’s next practice or competition, even if the first test did not indicate a concussion.
Additionally, the absence or presence of a concussion must be reviewed by a physician within 24 hours of the injury, and the team’s medical staff must inform the Director of the NBA Concussion Program, Dr. Jeffrey Kutcher, within 24 hours of the injury that a concussion evaluation was performed and relay the result of the evaluation.
If diagnosed with a concussion, the player is removed from play immediately and not allowed to return until he has completed the NBA’s return-to-participation process, which involves a brief period of complete rest followed by a gradual return to activity from stationary bike, to jogging, to agility work, to non-contact team drills. To move on to the next step, the player must be completely symptom free while performing the current activity level.
The NBA concussion policy ends thus: “It’s important to note that there is no timeframe to complete the process. Each injury and player is different and recovery time can vary in each case.”
U.S. Soccer: U.S. Soccer released its Concussion Initiative in December 2015, as part of a resolution to a proposed class-action lawsuit filed against U.S. Soccer and others.
The initiative provides educational materials and guidelines to member organizations, players, parents, coaches and referees regarding head injuries.
For specific age groups, the initiative also modifies substitution rules to allow players who may have suffered a concussion be evaluated during a game without penalty to their team, in addition to banning heading for children 10 and under and encouraging the limiting of heading in practice for children 11 to 13.
These rules are mandatory for U.S. Soccer Youth National Teams and Development Academy, as well as Major League Soccer youth club teams, and serve as recommendations for other associations, leagues and tournaments.
Pop Warner Football: Pop Warner has made a point of putting in place comprehensive and rigorous concussion protocol.
The home team or hosting organization must provide at the minimum, someone on site who is EMT qualified or Red Cross Community First Aid and Safety or P.R.E.P.A.R.E. Course certified.
A player suspected of having a concussion must be removed from practice or competition. If a medical professional is present, he or she can do an evaluation and has final authority on whether or not the player will return to the game.
After removal due to suspicion of a concussion, the player may not return until he has been evaluated by a licensed medical professional trained in concussion evaluation and management. Written clearance is required.
NFL: The concussion problem in the NFL is well documented, perhaps more than in any other sport.
Players must be educated on concussions before the season and do a baseline neurological exam.
A physician unaffiliated with any NFL team is assigned to each team to monitor games from the sidelines and determine when a hard hit warrants a concussion evaluation, but the final call in diagnosing a concussion and making return to play decisions lies with team doctor.
Two athletic trainers known as “spotters” sit in stadium booths with access to multiple camera angles of the game and are tasked with attempting to spot potential concussions. They then relay their observations to the medical personnel on the sidelines.
If a player shows or reports concussion symptoms, he must be removed from the game and undergo sideline evaluation protocol. If any elements of the sideline assessment are positive, the player must go to the locker room and go through the NFL Locker Room Comprehensive Concussion Assessment. If a concussion is diagnosed, or the player exhibits or reports one of the three “no-go” symptoms (loss of consciousness, confusion, amnesia), then he is removed from play. If a concussion is not diagnosed, follow-up assessments are required to check for delayed onset symptoms.
The concussed players may not return to full competition until asymptomatic and back to baseline cognitive function. Team doctor and independent neurological consultant must both clear the athlete.
The NFL can impose penalties if a team fails to follow protocol.