Concussion Return-to-Sport Steps and Combat Sports Suspensions

After a concussion, return to sport follows a stepwise strategy, and in combat sports the Association of Ringside Physicians recommends minimum suspensions after knockouts caused by blows to the head.1,5 This page shows the six steps from the latest international consensus, the red flags that need emergency care, and the suspension minimums used in boxing. It describes published frameworks; the decision to return to contact always belongs to a healthcare professional.1

What happened?

Rest is short, activity comes early

Current consensus recommends relative rest for up to the first two days, and light activity such as walking is acceptable as long as it does not more than mildly worsen symptoms.1 Early activity does not mean early contact: any risk of contact, collision or falls is avoided until a healthcare professional has cleared it.1

Repeated knockouts

In a study of 30 amateur boxers, reported in a 2013 paper, cerebrospinal fluid brain-injury biomarkers were raised in more than 80% one to six days after a bout, mostly without concussion symptoms, and about 20% still had raised levels after two weeks of rest.7 In my view, repeated knockouts are a warning sign, although no specific number of knockouts is a validated medical rule.5

References

Every figure and statement in this tool is linked to a source: the original study where my article cites one, otherwise my own article on the topic. The small numbers in the text refer to this list.

  1. Patricios et al. 2023. Consensus statement on concussion in sport: the 6th International Conference on Concussion in Sport–Amsterdam, October 2022. British Journal of Sports Medicine.
  2. Ringside physicians’ suspension guidance
  3. Dr. Antti Rintanen: Concussion Symptoms: What the Evidence Shows About Early Signs, Delayed Onset, and Recovery
  4. Echemendia et al. (Concussion in Sport Group) 2023. Sport Concussion Assessment Tool 6 (SCAT6). British Journal of Sports Medicine.
  5. Dr. Antti Rintanen: Concussions in Combat Athletes: What the Evidence Says About Risk, Recognition, and Recovery
  6. Putukian et al. 2023. Clinical recovery from concussion–return to school and sport: a systematic review and meta-analysis. British Journal of Sports Medicine.
  7. Neselius et al. 2013. Increased CSF levels of phosphorylated neurofilament heavy protein following bout in amateur boxers. PLoS One.

Sources

This tool is based on the articles below and the studies cited in them:

This tool is for general education. It does not diagnose, interpret your own results, give personal recommendations or replace an assessment by your doctor.