Are Concussion Tests a Reliable Tool for Determining Return to Play in Athletes?


Concussions in sports are all the buzz these days, as athletes, coaches, parents and clinicians seek solutions to the pervasive problem. Protective gear helps, but some argue that it gives athletes a false sense of confidence that may in fact increase the risk of a concussion or other injury. It is known that athletes who return to play after concussion have an increased risk of a second episode, and that risk has an inverse relationship with recovery time between the first incident and return to play. In other words, the less recovery time, the greater the risk.

The Value of Concussion Tests

Concussion tests are evaluative tools often used by sports teams, schools and coaches to determine, in part, whether an athlete has recovered sufficiently to return to play. The tests do not serve as stand-alone indicators of an athlete’s readiness to return to play, but are usually factored in with other things like self-reported symptoms, health care provider feedback and the athlete’s own confidence in their state of recovery.

Typically, a concussion test will be taken by healthy athletes prior to the playing season, and the results provide baseline measurements that can be used for comparison when an athlete sustains a concussion. While the idea may have some validity, many argue that the tests only offer data, which does not necessarily translate to information that can be used objectively. Some have accused the plethora of concussion tests that have emerged in recent years of giving a false sense of reassurance to athletes and parents, without making a dent in concussion statistics.

What Concussion Tests Evaluate

Computerized concussion tests like the popular ImPact test assess a battery of cognitive responses, including:

● Verbal memory
● Visual memory
● Processing speed
● Impulse control
● Reaction time

If the concussion post-injury score is lower than the pre-season baseline score, it may indicate that the athlete’s cognitive function is impaired. Lower post-injury scores may throw up a red flag signaling the athlete needs more advanced evaluation from a concussion specialist.

Where Concussion Tests Fall Short

Critics caution that computerized concussion tests can be misleading. Just because an athlete matches or exceeds their baseline scores, it does not mean they have fully recovered. What’s more, athletes who want to mask symptoms so they can more quickly return to play could use test scores as evidence that they are ready, when in fact they are not.

Test scores also do not necessarily reflect an athlete’s cognitive health. Many factors can influence test outcomes, including the testing environment, fatigue, sleep deprivation, and the athlete’s level of motivation. For example, an athlete may have had low motivation when completing the baseline test, but if return to play hangs in the balance, motivation to score well may be high during the retest. In young athletes whose brains are rapidly developing, baseline test scores may be even less reliable for assessing changes in cognitive function.

Another criticism of computerized concussion tests is that there is a great deal of money to be made by selling the tests to schools and sports teams. That, in some minds, poses a conflict of interest. Some suggest that the tests’ reliably may be grossly overstated by their creators. Others deem the tests useless, pointing out that the costs of the tests divert resources that schools could better spend elsewhere.

Putting the Athlete’s Health First

Whether computerized concussion tests are reliable or even useful will no doubt continue to be a hot topic. But at the end of the day, putting a player back in the game before they are ready is setting them up for subsequent concussions and untold cognitive repercussions later in life.

Concussed athletes need to be proactive and self-advocate for evaluation and treatment from an experienced concussion specialist. The team of concussion specialists and therapists at NYDNRehab have the education, experience and state-of-the-art equipment to thoroughly evaluate and treat concussions. Do not let a computerized test decide whether or not you are ready to return to play. Visit NYDNRehab and let the best concussion specialists in NYC evaluate and treat your concussion injury.


In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)


Complete tear of rectus femoris
with large hematoma (blood)


Separation of muscle ends due to tear elicited
on dynamic sonography examination

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