Contact Sports & Concussions

As the fall season approaches, teams are gathering to play football, soccer, field hockey, ice hockey and basketball teams.

This year, many student athletes will suffer a concussion while playing. It is important to know how to prevent and treat concussions and know when it is safe to return to play.

WHAT IS A CONCUSSION?

A concussion is a disturbance in brain function that occurs following either a blow to the head or as a result of the violent shaking of the head. In the United States, the annual incidence of sports-related concussion is estimated at 300,000. Estimates regarding the likelihood of an athlete in a contact sport experiencing a concussion may be as high as 19% per season. Although the majority of athletes who experience a concussion are likely to recover, an as yet unknown number of these individuals may experience chronic cognitive and neurobehavioral difficulties related to recurrent injury. It is important to recognize the presence of any loss or other alteration of consciousness (LOC). LOC is relatively rare and occurs in less than 10% of concussive injuries.

COMMON SIGNS AND SYMPTOMS

• Signs observed
  
  • Appears to be dazed or stunned
  • Is confused about assignment
  • Forgets plays
  • Is unsure of game, score, or opponent
  • Moves clumsily
  • Answers questions slowly
  • Loses consciousness (even temporarily)
  • Shows behavior or personality change
  • Forgets events prior to hit (retrograde amnesia)
  • Forgets events after hit (anterograde amnesia)

• Signs reported by athlete
  
  • Headache
  • Nausea
  • Balance problems or dizziness
  • Double or fuzzy vision
  • Sensitivity to light or noise
  • Feeling sluggish
  • Feeling "foggy"
  • Change in sleep pattern
  • Concentration or memory problems

POST-CONCUSSION SYNDROME

Although the majority of athletes who experience a concussion are likely to recover, an as yet unknown number of these individuals may experience chronic cognitive and neurobehavioral difficulties related to recurrent injury. Such symptoms may include chronic headaches, fatigue, sleep difficulties, personality change (e.g. increased irritability, emotionality), sensitivity to light/noise, dizziness when standing quickly, and deficits in short-term memory, problem solving and general academic functioning. This constellation of symptoms is referred to "Post-Concussion Syndrome" and can be quite disabling for an athlete. In some cases, such difficulties can be permanent and disabling. In addition to Post-Concussion Syndrome, suffering a second blow to the head while recovering from an initial concussion can have catastrophic consequences as in the case of "Second Impact Syndrome," which has led to approximately 30-40 deaths over the past decade.
Consulting w/ a Doctor

RECOVERY

Athletes that are not fully recovered from an initial concussion are significantly vulnerable for recurrent, cumulative, and even catastrophic consequences of a second concussive injury. Such difficulties are prevented if the athlete is allowed time to recover from concussion and return to play decisions are carefully made. No athlete should return to sport or other at-risk participation when symptoms of concussion are present and recovery is ongoing. In summary, the best way to prevent difficulties with concussion is to manage the injury properly when it does occur.

TREATMENT

At the forefront of proper concussion management is the implementation of baseline and/or post-injury neurocognitive testing. Such evaluation can help to objectively evaluate the concussed athlete's post-injury condition and track recovery for safe return to play, thus preventing the cumulative effects of concussion. In fact, neurocognitive testing has recently been called the "cornerstone" of proper concussion management by an international panel of sports medicine experts. Traditional neurological and radiologic procedures, such as CT, MRI, and EEG, although helpful in identifying more serious concerns (e.g. skull fracture, hematoma, contusion), are not useful in identifying the effects of concussion. Vienna Concussion Conference Recommendations: Athletes should complete the following step-wise process prior to return to play following concussion.

• • Removal from contest following an signs / symptoms of concussion
  • No return to play in current game
  • Medical evaluation following injury
    • Rule out more serious intracranial pathology
  • Step-wise return to play
    • No activity - rest until asymptomatic
    • Light aerobic exercise
    • Sport-specific training
    • Non-contact drills
    • Full-contact drills
    • Game play

The goal of treatment is to allow the brain injury to heal. Concussions are treated differently depending on their level of severity. Treatment may include:

• • Rest - provide adequate time for recovery. Do not rush back into daily activities for work or school.
  • Preventing re-injury - avoid activities that might jolt or jar your heard. Never return to a sports activity until your doctor has given you clearance. Ask when it's safe to drive a car, ride a bike, work or play at heights, or use heavy equipment.