Sports Concussions

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Sports Concussion Basics
It is estimated that over 300,000 sports related concussions occur every year. Football has the highest rate of concussions, but ice hockey, soccer, lacrosse and field-hockey are not far behind, and younger athletes are more susceptible. Long-term research suggests that 10-15% (some as high as 20%) of participants in contact sports suffer a concussion.

In lay terms, a concussion is a “brain sprain” or a “bruised brain.” A concussion is brain injury caused by a blow to the head, a fall, or another injury that jars or shakes the brain inside the skull. The brain is a soft organ surrounded by spinal fluid and protected by the hard skull which acts kind of like a helmet. Normally, the fluid around your brain acts like a cushion that keeps your brain from banging into your skull. But if your head or your body is hit hard, the brain can crash into your skull and get injured. The shaking causes energy to be created that travels through the brain, disrupting normal function.

Some people will have obvious symptoms of a concussion, such as passing out or forgetting what happened right before the injury. But other people won’t. You don’t have to pass out (lose consciousness) to have a concussion. With rest, most people fully recover from a concussion, sometimes within a few hours, but it can sometimes take a few weeks (or even months) to recover from more severe blows.

The human brain has not fully matured until the early 20′s. Younger brains take longer to recover from a concussion and may be more vulnerable to the effects of another concussion when it has not fully recovered from the previous one. In rare cases concussions cause more serious problems. Repeated concussions or a severe concussion may require surgery or lead to long-lasting problems. Because there is a chance of permanent brain problems, it is important to contact a doctor if you or someone you know has symptoms of a concussion. When in doubt – check it out.

What Happens During a Concussion
The human brain is very complex and it maintains a delicate balance between the chemicals inside and outside of its cells. During a concussion the membranes of the brain cells are distorted causing chemicals that are normally on the outside to rush inside the cells, forcing out the chemicals that are normally inside the cell. This starts what is known as a cascade of chemical changes in the brain. As it attempts to return to normal, the brain’s demand for energy (glucose or sugar) increases by about 150%. To complicate the issue, the brain’s ability to deliver the required glucose drops to only 50% of normal. This mismatch between supply and demand is what causes the problems after a concussion.

Types of Sports Concussions
Most sports concussions are divided into two types: simple and complex (also referred to as Uncomplicated or Prolonged). A simple concussion is when there is no detectable damage to the brain itself. A complex concussion is when there is overt or detectable damage to the brain such as a bruise or bleeding.

Many doctors also use a grading system where concussions are rated as grade 1, 2, or 3. In reality, there are over 20 different grading systems that have been used. Unfortunately, none of the grading systems have effectively established treatment guidelines and none have been able to accurately determine recovery rates.

When symptoms last more than three weeks, a diagnosis of Post Concussion Syndrome (PCS) is often made. It has been shown in research that dizziness directly after the injury often leads to an increased incidence of PCS. There are many medical options for athletes with PCS including therapy and medication.

Concussion Symptoms
You don’t necessarily have to lose consciousness to have a concussion, but if you did, then it is definitely considered a concussion. Just after a concussion an athlete may be confused and/or disoriented any may have a hard time recalling events immediately before or after the blow. The athlete’s balance may be affected and they may repeat themselves. Sensitivity to light and sound is common as well as headache and irritability. Below are common symptoms of a concussion:

  • Headache
  • Poor balance
  • Nausea/Vomiting
  • Affected smell
  • Fatigue
  • Irritability
  • Affected hearing
  • Tearfulness/Sadness
  • Feeling slowed down
  • Increased sleep
  • Decreased appetite
  • Feeling “foggy”
  • Decreased sleep
  • Sensitivity to light or noise
  • Blurred vision
  • Poor memory/concentration
  • Dizziness

Symptoms can linger for several days, and much longer in some cases. Headaches, fatigue, irritability, fogginess, and memory problems are common, but not the only symptoms. Sometimes there can be neck stiffness from the blow and balance problems.

What Do You Do If You Sustain a Concussion?
Typically, low-grade concussions do not require extensive medical treatment. Because of the potential for serious complications, they must be monitored closely and often after the event. If urgent medical attention is needed, you want it to be close by. You should be evaluated immediately after the concussion and closely monitored in case symptoms worsen. If there is symptoms worsen (such as lethargy, headache, vomiting, stiff neck, slurred speech, and confusion) then immediate medical care is required. If you were not evaluated at the event, you should contact a physician or seek an emergency room evaluation.

It is extremely important not to return an athlete to play before they have fully recovered from a concussion.

There is not one system for grading concussions, but doctors generally check all of your senses and ask questions to check your memory and how you respond. Sometimes a CT scan or MRI is taken to make sure your brain is not bruised or bleeding. These scans are non-invasive and give a much clearer picture of what is going on inside your skull.

Rest is the best way to recover from a concussion, but here are some tips to help you get better:

  • Get plenty of sleep at night, and take it easy during the day.
  • Avoid alcohol and illegal drugs.
  • Do not take any other medicine unless your doctor says it is okay.
  • Avoid activities that are physically or mentally demanding (including housework, exercise, schoolwork, video games, or using the computer).
  • Ask your doctor when it’s okay for you to drive a car, ride a bike, or operate machinery.
  • Use ice or a cold pack on any swelling for 10 to 20 minutes at a time. Put a thin cloth between the ice and your skin.
  • Use pain medicine as directed. Your doctor may give you a prescription for pain medicine or recommend you use a pain medicine that you can buy without a prescription.

Second Impact Syndrome
A second concussion sustained before the first one has fully healed is called second impact syndrome (SIS). SIS occurs when the brain losses its ability to control blood flow and the pressure builds up to unsafe levels and damages the brain. When SIS occurs, it can be life-threatening as the brain may swell rapidly and require emergency surgery. While SIS is rare, it has lead to rapid, severe and permanent brain injury and many do not survive. All of this is preventable which is why it is so important to allow a young athlete to fully recover before returning to sport.

Return to Sport After a Concussion
Concussions are unique to the individual, and each person will recover differently. No one can accurately predict when concussion symptoms will clear up, so it’s important to take things slowly.

A doctor must always determine when an athlete is ready to return to play. A gradual, incremental approach is recommended based on recommendations from the Zurich international panel of concussion experts. Before starting a return to play protocol, an athlete must be free from symptoms and not have any memory or concentration issues. After that, the Zurich panel recommends the following steps:

  • Day 1: light aerobic exercise (walking, swimming, or stationary cycling) keeping exercise heart rate less than 70% of maximum predicted heart rate. No resistance training
  • Day 2: sport-specific exercise, any activities that incorporate sport-specific skills (skating in hockey, running in soccer, etc). No head impact activities.
  • Day 3: non-contact training drills
  • Day 4: full contact practice, participate in normal practice activities
  • Day 5: return to competition

There should be approximately 24 hours between each step and the athlete must be free of concussion symptoms after each step. If concussion symptoms return, the athlete must rest (no exercising) until all symptoms have gone away then return to the previous level.

There does not seem to be a magic number of concussions that force an athlete to “retire” from sports. This is determined by the severity of the concussions and how long it takes for symptoms to clear.

The best method for determining recovery from a sports concussion is through a thorough medical assessment of cognitive abilities, balance and other possible symptoms. , While neurological examinations and CT scans or MRIs are relatively insensitive in detecting a sports concussion, tasks such as memory, concentration, reaction time, and how quickly you think are the most sensitive measures of a concussion. The best method for measuring the effects of sports concussion is through baseline testing BEFORE an athlete is concussed so a doctor can compare the results of the same athlete. This is why baseline testing has become so important to most sports concussion programs. Baseline tests such as ImPACT, Axon Sports, Concussion Vital Signs, and HeadMinder have been developed specifically for this purpose and the testing is simple and easy to understand. The results give a doctor an objective measure of cognition, allowing for a more accurate diagnosis and treatment plan.