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Background: Concussion guidelines recommend physical and cognitive rest until all postconcussion symptoms resolve, in part because of potential health risks, including catastrophic injury related to a second impact. However, when postconcussion symptoms persist for weeks or months, these risks are poorly characterized.Hypothesis: Physicians' perceived health risks and management strategies for patients with persistent postconcussion symptoms will vary.Study Design: Cross-sectional study.Level Of Evidence: Level 3.Methods: A survey of the physician members of the American College of Sports Medicine assessed the perceived health risks related to advancing activity, the indications for neuroimaging, and the referral patterns for patients with persistent postconcussion symptoms.Results: A total of 572 physicians completed the survey (response rate, 27.2%). The majority of physicians recommended physical rest (97.4%) and cognitive rest (93.8%) within the first week of injury. Perceived health risks related to advancing activity in the symptomatic patient differed at 2 weeks versus 3 months after injury (P < 0.001 for all comparisons). Respondents from the United States were more likely to list second impact syndrome as a potential health risk at 2 weeks compared with respondents from other countries (P = 0.04). The majority (56%) responded that the risk of second impact syndrome remains until all symptoms resolve. When postconcussion symptoms persist beyond 1 month, 61.9% of physicians responded that neuroimaging is indicated. Approximately 60% of respondents had access to a multidisciplinary concussion clinic within 60 miles of their practice.Conclusion: When postconcussion symptoms persist, the perceived health risks, management practices, and access to multidisciplinary care vary among physicians. [ABSTRACT FROM AUTHOR]

accounting for as much as 40% of all low back pain in this population. Currently, there is no evidence to guide physicians on when to make a safe referral to physical therapy [PT] for these patients. There were two primary objectives of this study: (1) to determine if the amount of time prior to referral to PT affects the time to make a full return to activity for patients with an acute spondylolysis (2) To assess the safety of an early referral to PT compared with a longer rest period prior to PT in patients with an acute spondylolysis. Methods: This was a retrospective study which consisted of the review of each patient's medical chart and lumbar imaging. Participants: One hundred and ninety-six patients with an acute spondylolysis injury met the inclusion criteria during the pre-selected review period. Patients were sub-grouped into 2 groups by physician referral patterns: an aggressive referral to PT group (< 10 weeks) and a conservative referral to PT group (> 10 weeks). Safety was assessed by calculating the number of adverse reactions experienced in each group during the course of treatment. Data Analysis: Mann-Whitney U tests were used to analyze the first study objective. Relative risk of an adverse reaction was calculated to assess the second study objective. Results: Median days to a full return to sport for aggressive PT referral group (115.5 days IQR 50.5) and conservative PT referral (140.0 days IQR 40.3) was significantly different (p = 0.003). A total of 11 patients had documented adverse reactions during the course of treatment for acute spondylolysis. Although there was a higher percentage of patients who experienced an adverse reaction in the conservative referral to PT group, this difference was not statistically significant (p = 0.509). Conclusions: The results of this retrospective study show that patients of physicians who referred to physical therapy sooner returned to sport more quickly without an increased risk of adverse reaction. [ABSTRACT FROM AUTHOR]

Objective: The term "post-traumatic migraine" (PTM) has been used to describe post-traumatic headaches (PTHs) that have associated migraine features, but studies of this relationship are lacking. The objective of the present study was to determine whether PTH correlates strongly with migraine symptoms among youth with concussion.Methods: Twenty-three symptoms were analyzed from a retrospective cohort of 1953 pediatric patients with concussion. A principal component analysis (PCA) with oblique Promax rotation was conducted to explore underlying symptom relationships in the full cohort and in subcohorts stratified by the presence (n = 414) or absence (n = 1526) of premorbid headache.Results: The mean patient age was 14.1 years; 63% were male. Headache was the most common postconcussion symptom, acknowledged by 69.4% of patients. When considering the full cohort, the PCA demonstrated clustering of headache with photophobia, phonophobia, nausea, dizziness, and neck pain. Similar clustering was present among patients without premorbid headaches. Repeating the analysis in the patients with preconcussion headaches led to elimination of neck pain from the cluster.Conclusions: PTH correlates strongly with other migraine symptoms among youth with concussion, regardless of premorbid headaches. This clustering of migraine symptoms supports the existence of PTM as a distinct clinical entity in some patients. [ABSTRACT FROM AUTHOR]