Returning to Combat Sports After Sustaining a Concussion

An article was published in the latest edition of the South African Journal of Sports Medicine levying criticism at professional boxing’s lack of standardized protocols for athletes to return to training/competition after suffering concussive injury.

The article, authored by Dr. Sethi from the Department of Neurology, New York Presbyterian Hospital is titled “Post-concussion return to boxing protocol” and can be found here.

Dr. Sethi fairly points out that

Immediately following a concussion, an athlete is usually advised physical and cognitive rest until post-concussion symptoms abate. The athlete then enters a stepwise return-to-play protocol. Premature return to play risks a second concussion, second impact syndrome, exacerbation and persistence of post-concussive symptoms. Various sports governing organisations such as the National Football League have developed postconcussion return to play protocols”

After noting professional boxing lacks a standardized protocol for return to sport following concussion Dr. Sethi proposes the following criteria to be adopted:

The following post-concussion return to boxing protocol is proposed based on evidence from other sports and clinical acumen:

Once the boxer is symptom free for at least 24 hours and a release has been signed by the treating physician, he/she can begin a graded return to boxing as detailed below.

Day 1: Light aerobic activity (walking or stationary bike for 10 minutes, no resistance training)

Day 2: Sport-specific activity (jumping rope, shadow boxing)

Day 3: Non-contact training drills (Skill drills-pad work, speed bag, heavy bag)

Day 4: Full-contact practice (sparring with head gear)

Day 5: Return to boxing (return to competitive boxing occurs when the period of mandatory medical suspension has expired)

Each of the above steps should take 24 hours so that a boxer would take approximately one week to progress through the full post-concussion protocol once they are asymptomatic at rest. If any post- concussion symptoms occur while in the stepwise return to boxing programme, then the boxer should be instructed to return to the previous asymptomatic level and try to progress again after a further 24-hour period of rest has passed.

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