A reported 1.6 to 3.8 million sports- and recreation-related traumatic brain injuries occur each year in the United States,1 many of which result in long-lasting brain damage and in some cases death.

Fortunately, best practices for traumatic brain have evolved as new data. Gary W. Jay, MD, who has worked in pain medicine and neurorehabilitation for more than 3 decades, discussed some of these practices in a master class session this week.

Discussing minor or mild traumatic brain injury, “or the clinical entity in which the brain has sustained a pathologic injury,” Dr. Jay said these injuries have various physiologic aspects that must be considered when treating them, such as elements of rotation at the time of the injury.

He noted that although they may be characterized as “minor,” not infrequently these types of “brain injuries are substantial and the only things missing when the diagnosis is made in the emergency department may be blood and skull fracture.”

Back to Concussions?

Particularly as the back-to-school season is just getting started and football season is now in full swing, Dr. Jay cautions that it is important for clinicians to recognize a sports-related concussion. He discussed how best to evaluate concussions and offered some pearls about sending a student athlete back out on the field.

The Centers for Disease Control and Prevention (CDC) defines a “concussion as a type of traumatic brain injury—or TBI—caused by a bump, blow, or jolt to the head or by a hit to the body that causes the head and brain to move rapidly back and forth. This sudden movement can cause the brain to bounce around or twist in the skull, stretching and damaging the brain cells and creating chemical changes in the brain.”

The CDC advocates a multistep approach to a return to play after a sports-related concussion, starting first with the athlete heading back to school, then light aerobic activity, then moderate activity, followed by heavier noncontact activity, then practice with full contact, and finally competition.

During his presentation, Dr. Jay also detailed the neurologic and neurophysiologic underpinnings of chronic traumatic encephalopathy.

Beyond the patient, Dr. Jay noted that it is important for clinicians to glean information regarding traumatic brain injuries from patients’ family, spouse, and significant others.


1. Langlois JA, Rutland-Brown W, Wald MM. The epidemiology and impact of traumatic brain injury: a brief overview. J Head Trauma Rehabil. 2006;21(5):375-378.