Determination of Safe Return to Play for Athletes Recovering from Infectious Mononucleosis

Abstract

No strong evidence-based information supports use of a single parameter to predict the safe return to sports participation. Current consensus supports that athletes be afebrile, well hydrated, and asymptomatic with no palpable liver or spleen. Clinical judgment incorporating these criteria 1 month after diagnosis has been suggested as a safe predictor for gradual return to competition. These conditions for return to play do not guarantee that the spleen has returned to normal size and compliance, or that the risk of spleen rupture has returned to baseline. For those athletes participating in contact sports who wish to return to sports in an earlier time frame, or those with an equivocal examination, radiographic modalities may be used to help determine liver and spleen size. Further studies are required to support this practice.

Mononucleosis and Athletic Participation: An Evidence-Based Subject Review

“…Some reviewers have noted that the presence of palatal petechiae may be present, with 1 study suggesting that the presence of palatal petechiae, gastrointestinal symptoms, and an insidious onset of symptoms portend a longer duration of illness. 12,[15][16][17] …”

Exercise and Immunity

“…Intensive endurance training or competition which last for at least one hour stimulates the immune system sharply in the beginning, but a few hours after exercise/competition, a weakened immune system results [46]. This means that the immune system in the hours after hard exercise/competition has a weakened ability to fight against bacteria and viruses and the susceptibility to infection is temporarily increased [47]. This effect is seen in both untrained and trained individuals.…”

Return to play after health complications associated with infectious mononucleosis guided on autonomic nervous system activity in elite athlete: A case study

“…In our study, we investigated a border line or mild elevated values of ALT (AST only in one measurement) while liver and spleen had, according to a medical report normal size. From review of Waninger and Harcke (2005) results that there has been no defi nitive correlation identifi ed between an increase in of the spleen and blood liver/enzyme parameters, and further, no data support the use of serial hematological studies as an indicator of safety return to play. Therefore, we suppose that in given case the dynamics of liver enzymes did not indicate an excessive increase in training load during convalescence periods.…”

“…An investigation of functional state or size of liver and spleen could be helpful in determination of time frame of the return to play (Putukian et al, 2008;Waninger & Harcke, 2005). In our study, we investigated a border line or mild elevated values of ALT (AST only in one measurement) while liver and spleen had, according to a medical report normal size.…”

“…The consensus from more current literature is that light noncontact activities may commence 3 weeks from symptom onset, but the returning to contact acti vities is more complicated (Putukian et al, 2008). More over, from review of Waninger and Harcke (2005) results that no strong evidence-based information supports use of a single parameter to predict the safe return to sport participation.…”