With millions of high school students across the country returning to school and fall sports, it is the time of the year that parents, coaches, teachers and physicians should be thinking about how to provide them with a safe experience. Concussions have received a lot of media attention recently, and for good reason. A concussion can have a significant short and long-term impact on everything from academics to sports, social interactions and every day activities.
It is estimated that there are up to 300,000 sport-related concussions in the United States each year. According to a 2007 study, concussions were responsible for nearly 9% of all high school athletic injuries. This is truly a remarkable number. Early identification and proper management of a concussion will play a crucial role in providing the best possible outcome. The goal of this article is to help educate coaches, parents, referees, teammates and anyone involved with youth sports on the common signs and symptoms of a concussion and what to do if you suspect a child has a head injury.
A concussion is defined as a trauma- induced functional neurologic deficit. In other words, any forceful blow to the head or body that results in rapid movement of the head can lead to changes in the way the brain functions. This means that a concussion does not require a direct blow to the head but any force which jolts the brain hard enough to affect brain function. It is important to realize that loss of consciousness is not required for a head injury to be diagnosed as a concussion; in fact most people who suffer from concussions do not lose consciousness.
In identifying an athlete with a concussion, we look for the most common signs and symptoms. Symptoms are conditions that the athlete will report themselves, things that are affecting them and what they are experiencing. A sign is something that a coach, parent, referee or teammate may notice when evaluating an athlete on or off the field.
Commons symptoms that may be reported:
• Headache or “pressure” in the head
• Nausea or vomiting
• Balance problems or dizziness
• Double or blurry vision
• Sensitivity to light or noise
• Feeling sluggish, hazy, foggy or groggy
• Concentration or memory problems
• Does not “feel right”
Common signs observed by parents, coaches, trainers or teammates:
• Appearing dazed or stunned
• Is confused about assignment or position
• Forgets plays
• Is unsure of the game, score or opponent
• Moves clumsily
• Answers questions slowly
• Loses consciousness
• Shows behavioral or personality changes
• Cannot recall events before or after a hit or fall
If you suspect that an athlete has a concussion, he or she should be immediately removed from play. An athletic trainer or experienced healthcare professional should be on hand to perform a formal evaluation of the injury. For years, athletes described getting their “bell rung” or seeing stars for a few minutes before returning to the field. In most cases, these individuals had probably suffered a concussion but because there was not enough information available to coaches and parents, these concussion symptoms were often ignored. Coaches, parents and teammates should not allow participants with these symptoms to simply “shake it off.”
Once a concussion is diagnosed by an experienced athletic trainer or other qualified health care professional, each athlete must carefully follow a return to play protocol. The brain requires complete rest to recover from a head injury. This requires not only physical rest, but also cognitive rest from everyday activities like video games, text messaging and reading. In many cases, modifications of school work or assignments may be necessary. An experienced physician should see the injured athlete within one to three days of the head injury and make formal recommendations for cognitive and physical rest and any academic accommodations. If possible, the individual should be monitored daily by an athletic trainer and seen by a physician on a weekly basis until all symptoms have subsided. At that time, a post-injury neurocognitive (ImPACT) test should be performed to make sure that brain function is returning to normal.
Once symptoms have resolved for at least 24 hours, a formal return to play protocol can begin. This protocol will include a six-step process which will allow the athlete to progress from light activity (walking or swimming) to full contact practice. If symptoms do not return and the protocol has been completed, the athlete will be eligible to return to play without restriction. There is no firm time-table for the completion of this process. If symptoms do not resolve, it could take several weeks or even longer. If symptoms resolve quickly and do not return, full sports clearance may only require a week or two.
At Access Sports Medicine & Orthopaedics, we offer Free Baseline ImPACT Testing to athletes. A baseline test is an important first step in concussion management. In the event of a head injury, we can compare a post-injury test to a baseline to help ensure that the brain has returned to normal function. Our team of experienced physicians, physician assistants, nurse practitioners and athletic trainers are trained to evaluate athletes for concussion and use a formalized protocol to ensure a safe return to play. Unfortunately, we cannot take all risk of concussion out of youth sports, but with education and awareness, we can try to prevent the potential long term effects of premature return to play and repeat concussions.
Kevin D. Heaton, DO is a primary care physician fellowship-trained in sports medicine. He specializes in the non-operative treatment of sports related injuries. He has experience with and training in musculoskeletal ultrasound diagnosis and injection, platelet-rich plasma therapy and concussion management utilizing ImPACT neurocognitive testing. Dr. Heaton has experience in treating Division I Collegiate and High School level athletes and oversees the Athletic Training program at Access Sports Medicine & Orthopaedics.