Wednesday, May 04, 2016 Study: High School Football Players Experience More Concussion Symptoms, Longer Return-to-Play Times Than Youth League or College Counterparts Researchers have found that high school and college football players report more concussion symptoms than youth league players, and that youth league players tend to return to play within 24 hours of injury at a higher rate than their older counterparts. What they haven't figured out is what accounts for the differences, although they have a few ideas. Authors of a study e-published ahead of print in JAMA Pediatrics tracked athletic trainer-reported diagnoses, symptoms, and return-to-play rates of 1,429 sports-related concussions among the 3 levels of football during the 2012-2014 seasons. The concussion data were drawn from 310 youth football team seasons, 184 high school team seasons, and 71 college team seasons. Researchers used a symptom cluster system to organize 17 concussion-related symptoms into 4 groups—cognitive, migraine, neuropsychiatric, and sleep—and tallied up all symptoms reported from initial injury to return to play, not just those reported at the time of the concussion. Here's what they found: Across all concussions at all levels of play, an average of 5.48 symptoms were reported, with headache (94.3%), dizziness (75%), and difficulty concentrating (60.5%) being most common. The average number of symptoms reported trended higher for high school players (5.6) and college players (5.56) than for youth sports players (4.76). Within the symptom clusters, cognitive symptoms were experienced more frequently among high school and college players than among the youth league players. High school athletes reported higher rates of neurocognitive symptoms than the other groups, while college players reported a higher rate of sleep symptoms. High school players were more likely to have a return-to-play wait of at least 30 days (19.5%), followed by youth (16.3%) and college players (7%). Just over 10% of youth players returned to play within 24 hours of the injury, a rate more than twice that of college athletes (4.7% returned within 24 hours), and more than 10 times more than high school players (.8% returned within 24 hours). Very few concussions resulted in loss of consciousness, a finding that authors believe "further [highlights] the limited utility of that symptom in diagnosing concussion." Researchers speculated on a number of possible reasons for the various differences among player groups. For example, the higher rate of cognitive symptoms experienced by high school players may be related to the fact that growth in brain gray matter peaks in adolescence, they write, and longer return to play times among this group could have something to do with "longer durations of class without breaks, which prolong symptom recovery." When it comes to the number of players who return to play within 24 hours, authors believe those rates might be partly accounted for by athletes presenting with delayed concussion symptoms, as well as "disagreement between athletic trainers and physicians" over a concussion assessment. The much higher rates of return to play within 24 hours for youth players may be explained by that age group's "struggle" to identify and describe their symptoms to athletic trainers, which authors believe presents a challenge of its own. "It is imperative to educate athletic trainers, parents, coaches, and officials on recognition and management of concussions in youth," they write. "This should include strategies on how to effectively elicit symptoms in this younger age group because they may be at greater risk for second impact syndrome." Physical therapists have a critical role in concussion prevention and management. APTA offers multiple resources on concussion, which include a Traumatic Brain Injury webpage, and a clinical summary on concussion available for free to members on PTNow. The association also offers a patient-focused Physical Therapist's Guide to Concussion on APTA's MoveForwardPT.com consumer website. Continuing education offerings from APTA include the prerecorded webinar "Managing Concussions With an Interprofessional Team" available through the APTA Learning Center. Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website. Even more information on concussion and youth sports injuries is available at the NEXT Conference and Exposition, June 8-11 in Nashville. Related sessions include "Concussion: Evidence-Informed Rehabilitation" and "The Young Athlete: Injury Prevention, Training, and Exercise Prescription for Performance Enhancement." Advance registration discounts end May 4.