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National Football League Experiences With Return to Play After Concussion

Ira R. Casson, MD; Elliot J. Pellman, MD; David C. Viano, DrMed, PhD
Arch Neurol. 2009;66(3):416-421. doi:10.1001/archneurol.2008.592.
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We considered Dr Mayers' report of his experiences with concussed athletes and his brief review of recent, basic science research studies on head injury.1 However, we respectfully disagree with the conclusion that “a postconcussion return-to-play (RTP) interval of at least 4 weeks is imperative.”1 In essence, Dr Mayers concludes that since current clinical practices regarding RTP are not based on scientific evidence and because some basic laboratory research suggests that changes in the brain following concussion persist for at least 4 weeks following injury, clinicians must revise their current practice by mandating at least a 4-week RTP interval for all concussed athletes. We believe that the foundation for Dr Mayers' conclusion is flawed owing to a misinterpretation and misapplication of basic research results to the clinical sphere and his omission of the current state of clinical research on sports-related concussions.

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