ased on data from the Centers for Disease Control (CDC), approximately
200,000 people in the United States suffer a concussion while playing
sports every year. Concussions can occur in any sport and affect all athletes.
Concussions, also known as mild traumatic brain injury (MTBI), have recently
made headlines with reports about returning to play too soon. There have
also been reports of long term consequences due to repetitive concussions
resulting in premature deteriorating brain function. Recognizing concussion
and providing proper treatment is most important for the young athlete
whose brain is still developing and considered immature until the third
decade of life.
What is a concussion?
Unfortunately, there is no clear definition of a concussion. A concussion
occurs from a direct or indirect blow to the head that causes the brain
to rapidly move back and forth in the skull. This injury causes the brain
to revert to safety mode by clamping down on the blood flow into the brain.
This temporary impairment leads to the common symptoms an athlete may
exhibit. Most concussions are of short duration and athletes usually recover
within 7-10 days.
Symptoms of a concussion.
Concussion causes a variety of acute and delayed symptoms. Some symptoms
are physical manifestations, such as drowsiness. Others are cognitive,
like memory loss. These patients can also be more emotional and quick
to lose their temper.
The most common symptoms of concussion include:
- Memory loss
- Balance problems, dizziness
- Light hypersensitivity
Thorough evaluation is required.
There is no blood test or radiologic scan that can diagnose a concussion.
Imaging tests such as CT scans and MRIs typically do not detect the bleeding
or bruising evident in brain damage. Evaluation for a concussion needs
to be performed by a medical provider that is up to date on concussion
management. Long gone are the days of a physician seeing an athlete and
telling the parents, “He just got his bell rung. He should be able
to play next Friday.” Assessment should be on an individual basis
as every athlete heals at a different pace. Some concussions take multiple
weeks to heal.
As stated previously, results from a CT scan or MRI often appear normal
after concussion and are usually only utilized if the athlete loses consciousness
or a spine injury is suspected. Most providers will initiate an evaluation
with a cursory neurologic examination to assess for balance, coordination,
vision, hearing and reflexes. After the initial exam, the athlete will
perform a neuropsychological test.
Southeast Georgia Health System provides the ImPACT neurocognitive test
in Brunswick, a scientifically validated computerized concussion management
- Allows the provider to evaluate many cognitive parameters, such as memory
and reaction time, in an individual athlete.
- Provides valuable information on a range of mental functions, including
short-term memory, attention, concentration, problem solving and reaction
time. All of these cognitive processes can be affected by a concussion.
- Allows the provider to assess how quickly the patient is healing from a
Rest is the best medicine.
The key to healing from a concussion is complete rest. This not only includes
physical rest, but more importantly, mental rest to give the brain time
to heal. In today’s world of smart phones streaming multiple forms
of social media, this constant stimulation can be overwhelming to a concussed
brain, resulting in prolonged symptoms and delayed healing. Therefore
reading, computer work, smart phones, video games and even television
should be limited until all symptoms have resolved. This typically takes
around 7 to 10 days, however, some studies show that a concussed brain
may take weeks to return to baseline.
Once the athlete is free of symptoms, gradually increasing stress on the
brain with slow return to physical and mental activity is recommended.
Most concussion programs have a concussion protocol to slowly and incrementally
bring the player back to full activity over a week. If symptoms return
at any point during this process, the activity is decreased until symptoms
resolve and then the challenges are reinitiated until full activity is
accomplished. Once this has occurred, the athlete may return to play.
Back on the field.
Return to play guidelines should be followed closely since getting back
into a game too soon puts an athlete at risk for another concussion. If
an athlete suffers another concussion before the first has healed, it
may take even longer for symptoms to resolve and may lead to long-term
issues, such as learning difficulties and chronic headaches. Although
rare, repeat concussions that occur before a previous concussion has healed
can cause permanent brain damage or even death from a phenomenon called
second impact syndrome.
It’s not just for your safety. It’s the law.
In 2010, the American Academy of Pediatrics recommended that young athletes
with concussions be evaluated and cleared by a doctor before returning
to sports. The American Academy of Neurology has issued similar statements
and stressed that those doctors should be trained in managing concussions.
This has been followed by many states enacting legislation with these
same recommendations, including the Georgia Return to Play Act in 2013.
This legislation, like others, state that all parents of children in sports
should receive information on concussions; if a concussion is suspected,
the athlete is removed from play and cannot return to play until properly
cleared by a medical provider.
Sports equipment cannot definitely prevent concussions; young athletes
must be trained in safe sports technique. Athletes, parents and coaches
all play a role in concussion management by recognizing the symptoms,
removing the injured athlete from play and realizing that being patient
and giving your brain the proper amount of time to heal from a concussion
can prevent repeat injury and long term consequences.