To the Editor I read with interest the article by Dr Cantu1 about when to tell your patient with concussion and postconcussion syndrome that it is time to hang up his or her gloves, football gear, hockey stick, or soccer shoes and retire. As a neurologist, I find myself increasingly struggling with this decision-making process. When it comes to the athlete who indulges in a sport primarily for recreational and exercise purposes, the decision is easy both for me to make and for my patient to accept. Better be safe than sorry! When it comes to the professional or collegiate athlete, the stakes are much higher, including the potential loss of livelihood (eg, salary, winnings, endorsement incomes, or a lucrative athletic scholarship) not just for him or her, but his or her whole family. How can I advise that when we all know of athletes who have come back from devastating knockouts in the ring or concussions on the playing field only to compete and excel at the highest echelon of his or her chosen sport? Dr Cantu is indeed right when he stresses the need for further evidence-based research in this area. One size does not fit all when it comes to return to play vs permanent retirement decisions in patients with concussion.
Sethi NK. When to Tell an Athlete to Stop Playing. JAMA Neurol. 2014;71(5):654–655. doi:10.1001/jamaneurol.2013.6411
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