POSTURAL ORTHOSTATIC TACHYCARDIA SYNDROME (POTS): ITS RELEVANCE, AND IMPORTANCE, IN THE MANAGEMENT OF SPORT RELATED CONCUSSION

Abstract

Recent evidence suggests that concussion affects the autonomic nervous system (ANS), and that dysfunction of the ANS may be a factor that can contribute to persistent post-concussion symptoms. [1-3]  The 2017 Concussion in Sport Group (CISG) international consensus statement on concussion in sport [4] defined sport related concussion (SRC) as a “traumatic brain injury induced by biomechanical forces.” The CISG expert consensus [4] further defined persistent symptoms following SRC as “failure of normal clinical recovery – that is, symptoms that persist beyond expected time frames (i.e. >10-14 days in adults and >4weeks in children).” Persistent symptoms following SRC does not represent a single pathophysiological entity, but a collection of post-traumatic symptoms that may be linked to coexisting and/or confounding factors, requiring a detailed multimodal clinical assessment to identify specific primary and secondary pathologies that may be contributing to persisting symptoms.[4]  The American Medical Society for Sports Medicine (AMSSM) position statement on concussion in sport,[5] published in 2019, defined concussion as “a traumatically induced transient disturbance of brain function that involves a complex pathophysiological process.” This pathophysiological process was described in the AMSSM position statement [5] as being “not completely understood but has been characterised as force delivered to the brain causing disruptive stretching of neuronal cell membranes and axons resulting in a complex cascade of ionic, metabolic and pathophysiological events.”