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NFL issues stricter guidelines for returning to play following concussion

The treatment of football players with concussions has put the NFL in the spotlight in recent months, including two congressional hearings with testimony by former players and coaches, and the launch of an NFL public service campaign on the subject.

Last month, NFL Commissioner Roger Goodell notified teams of new and expanded return-to-play guidelines, developed by the NFL's medical committee on concussions in conjunction with team doctors, outside medical experts, and the NFL Players Association. The new guidelines provide more specificity in making return-to-play decisions and supplement the 2007 statement that encouraged team physicians and athletic trainers to continue taking a conservative approach to treating concussions. That statement established that a player should not return to the same game after a concussion if the team medical staff determined that he had lost consciousness.

The new 2009 statement advises that a player who suffers a concussion should not return to play or practice on the same day if he shows any signs or symptoms of a concussion that are outlined in the return-to-play statement. It further states:

"Once removed for the duration of a practice or game, the player should not be considered for return-to-football activities until he is fully asymptomatic, both at rest and after exertion, has a normal neurological examination, normal neuropsychological testing, and has been cleared to return by both team physicians and an independent neurological consultant. A critical element of managing concussions is candid reporting by players of their symptoms following an injury. Accordingly, players are to be encouraged to be candid with team medical staffs and to fully disclose any signs or symptoms that may be associated with a concussion."

Based on the 2009 statement, a player who suffers a concussion should not return to play or practice on the same day if any of the following symptoms or signs is identified based on the initial medical evaluation of the player:

Loss of consciousness

Confusion as evidenced by disorientation to person, time or place; inability to respond appropriately to questions; or inability to remember assignments or plays

Amnesia as evidenced by a gap in memory for events occurring just prior to the injury; inability to learn and retain new information; or a gap in memory for events that occurred after the injury

Abnormal neurological examination, such as abnormal pupillary response, persistent dizziness or vertigo, or abnormal balance on sideline testing

New and persistent headache, particularly if accompanied by photosensitivity, nausea, vomiting or dizziness

Any other persistent signs or symptoms of concussion

"The evidence demonstrates that team medical staffs have been addressing concussions in an increasingly cautious and conservative way," Commissioner Goodell said in a memo to the NFL clubs. "This new return-to-play statement reinforces our commitment to advancing player safety. Along with improved equipment, better education, and rule changes designed to reduce impacts to the head, it will make our game safer, and set an important example for players at all levels of play."

players are to be encouraged to be candid with team medical staffs and to fully disclose any signs or symptoms that may be associated with a concussion.