Recently our office presented a talk to a group of local youth coaches about prevention of concussions and proper decisions regarding return to play.
This topic has been the subject of intense debate among medical and sports authorities for about a decade.
Concussions are on the increase in youth as well as collegiate and professional sports.
In years past, athletes were returned to play after a mild head injury if they seemed to recover after a few minutes. The thought was that the player had just been “dinged” and after they “shake the cobwebs loose” they were ready to return to action.
Unfortunately, this ignorance of the true effects of even a mild concussion led to devastating consequences for young athletes that suffered from undiagnosed brain injury.
Concussion is a traumatic brain injury and as such it should be considered a critically important event. All concussions, regardless of how mild, should be evaluated by a doctor.
Symptoms of concussion range widely and can include, headache, confusion, balance issues, visual problems, ringing in the ears, emotional changes, trouble sleeping, trouble with concentration and memory, changes in school performance, personality changes and other neurological issues.
Importantly, a loss of consciousness is often not present when concussion occurs. However, even a brief loss of consciousness may indicate a more severe brain injury.
Some individuals are much more susceptible to concussion than others. Various physiological factors such as hydration, anatomic variables, previous head injury, age and others play a role in determining whether a person is more likely to sustain a concussion.
One of the most important issues that coaches, players, medical professionals, athletic trainers and even parents much consider is determining when it is safe for an athlete to return to play after a concussion.
General rules are that a athlete must be completely symptom free and taking no medication for at least 24 hours. After this time limit has been met, the player should be returned to play gradually. For example, the first step would be to work out with light aerobic exercise such as a stationary bicycle for a half hour. After this is accomplished, allow 24 hours before the next step, which would be some sport-specific exercise. The next step would be participating in non-contact training drills, then followed by full contact practice, ultimately leading to return to competition.
Note that each of the steps above should be separated by 24 hours rest period to evaluate response to the activity. Any recurrence of any symptoms mandates a 24 hour symptom free period and starting over at step 1.
Even though an athlete may be intent on getting back in the game, their future health is so threatened by a concussion that following the return to play guidelines are critically important.
Concussion is often called an invisible injury due to the fact that it may not be obvious that a brain injury has occurred simply by examining the player. The player’s symptoms and behavior are the clues to the diagnosis. This lack of obvious outward signs of injury are also what leads to the potential for severe catastrophic secondary injury.
People that have suffered a concussion are vulnerable to secondary brain injury after the first injury. Although most cases of concussion resolve on their own after a period of rest and conservative care, secondary brain injury is often fatal.
The risk of second impact injury is the primary consideration for allowing sufficient time to recover from even a mild concussion before returning to sports or other activities that might present a risk of head trauma.
The simplest type of advice for any coach, athlete or parent when faced with a situation where a concussion is suspected is, “If in doubt, sit them out.” If a concussion is suspected it is imperative that the athlete be evaluated by a doctor prior to resuming sports activity.
Unfortunately, even mild concussions can produce risk of learning difficulties or other cognitive problems that may be long lasting.
If your child has sustained a concussion, follow the medical advice to the letter. Your child’s future may depend on it.
