What is a Concussion?
Concussion injuries are coming into the spotlight as some of the most challenging and important injuries to diagnose and treat effectively. The technical definition of a sports-related concussion is as follows: A traumatic brain injury induced by biomechanical forces, that results in a rapid onset of short-lived impairment of neurological function. This can come from a direct blow to the head, such as from an elbow or ball, or can be indirect, such as when a player gets tackled in the body, and the resulting whiplash causes the injury to the brain.
How do I know if I or my child has a Concussion?
Concussion can be a very tricky injury to recognize, as there is no exact, consistent, set of symptoms or signs that indicate a concussion. Symptoms can include, but are not limited to, headache, brain fog, loss of consciousness, balance impairment and behavioral changes such as irritability, slowed reaction times, amnesia, and/or sleep disturbances. Currently, the best way to recognize and diagnose a potential concussion at the time of injury is using a Sports Concussion Assessment Tool, Version 5 (SCAT5), which is widely available, and can be found in a basic google search. This tool tests for various cognitive, attention and memory deficiencies. At this time, advanced imaging such as CT/MRI, does not provide any further useful information about the presence or severity of a concussion, but are useful in investigating more severe head injuries if any red flags present after the initial injury.
Red Flags for Severe Head Injuries.
First of all, if there is any kind of head injury, the player should be removed from the field of play immediately. The athlete should be taken through the SCAT5, or, if no qualified physician is present, the Standardized Assessment of Concussion (SAC) tool. If testing shows any indication that a concussion might be present, the player should not be allowed to be allowed back into the game on that same day. They must also be monitored continuously to ensure there is no worsening of symptoms.
Red Flags to be aware of that would indicate a more severe brain injury or brain bleed, would be rapid deterioration of neurological symptoms, loss of consciousness, seizure, worsening headache over time, repeated vomiting, and/or new neck pain. If any of these symptoms are present or become present, you should seek 911 emergency services immediately. Be aware, there may be a latent period after the initial head injury, in which the brain bleed is building pressure. So, even if the athlete doesn’t initially present any red flag symptoms, they may develop these symptoms over time, which makes continuous monitoring and exams for 2-3 hours post injury paramount to athlete safety.
No red flags, so what do we do after a Concussion?
As mentioned above, the athlete should be taken out of the game, and under no circumstances, should they be allowed to rejoin again that day. There is much debate on the best recovery/treatment of concussion, but the overall consensus is at least one week of recovery before returning to full play. Start with simple activities that do not provoke symptoms, and then move gradually to light aerobic exercise, sport specific exercise, non-contact training drills, full contact practice, and then finally return to sport. Allow for 24-48 hours for each of these phases, and if any provoke symptoms, return to the previous phase. If symptoms are persistent for more than two weeks, it warrants a referral to a licensed healthcare professional. Research has shown some benefit for vestibular and psychological rehabilitation, as well as cervical spine care by licensed chiropractors, physical therapists, and/or sports medicine physicians.
Key Take Aways:
An athlete even suspected of having a concussion, should never be returned to sport on the same day. Concussed athletes should be proper assessed, and be monitored continuously over the initial 2-3 hours after injury. If there are any red flags of significant neurological symptoms or deterioration of state, 911 would should be notified, and emergency procedures be taken. Concussion recovery should be at least a week with a graded return to activity and sport. Concussion injuries are an unfortunate part of sport, but with proper diagnosis and management, can be only a small setback in an athlete’s game and health.