Understanding Concussion in Sports
Misunderstood and Often Under Reported by Athletes
Reddy and Collins (2009) reported in Current Sports Medicine Report that new research “has transformed all aspects of concussion management, from on-field evaluation through return-to-play guidelines”. There is a paradigm shift underway throughout the field of sports medicine with the message that concussive injuries to the brain need to be treated on an individual basis.
The old concussion grading scales are now obsolete. These old scales used to be based on the length of time that an individual was unconscious. It is now widely recognized that “loss of conscious” is not a good predictor on the severity of a concussion. The symptom that is the best predictor for lingering outcomes in concussions is “fogginess” (Collins, M., 2009).
Symptoms of Concussion
Collins (May 15, 2009) stated in his presentation, Management of Sports Concussion in High School Athlete: What are we learning? (Annual National Summit on Concussion and Other Sports Medicine Injuries, Los Angeles), that the symptom of “fogginess” is the best predictor for an injury with a more lengthy outcome.
The difficulty is that “fogginess” is not an objective symptom that can be measured. It is something that is felt by the athlete, but not seen by the medical or coaching staff. It is under reported because athletes are not aware that this is a prime symptom of concussion.
Herein lies one of the difficulties of recognizing this type of injury. The athlete can continue to compete without anyone knowing that there is a problem. In many cases, there are no obvious outward signs.
This athlete is then also at risk for further injury possibly resulting in the worst case scenario of second impact syndrome. Second impact syndrome is often fatal and is the result of a "second impact" to the brain before an athlete's initial concussion has healed.
The message needs to be that any athlete who receives a blow to the head or an athlete who sustains a quick acceleration/deceleration mechanism to the head needs to be carefully monitored for symptoms of concussion. These symptoms include:
- Fogginess
- Difficulty in concentration
- Headache
- Light sensitivity
- Nausea/vomiting
- Dizziness
- Difficulty in balancing
- Memory deficits
Management of Concussion
If any of these symptoms are present, the athlete needs to be immediately pulled from competition/practice and further evaluated. If the sporting event is not covered by medical personnel (certified athletic trainer, team physician), then the athlete needs to be referred for immediate medical evaluation.
Athletes with any lingering symptoms should not be allowed to compete at any level in practices or competitions. Athletes need to be cleared by a physician and be completely asymptomatic (symptom free) prior to returning to exercising.
New research has also revealed that concussion injuries heal quicker when the athlete is not exercising (Collins, 2009). The management of these athletes also includes limiting school in severe cases so that the brain can rest from both cognitive and physiological work.
Time to Recovery
Collins, Lovell, Iveson, Ide, and Maroon published their research analyzing the time to recovery in high school football players who had sustained concussions over a three year period in the Journal of Neurosurgery (2006). They analyzed the recovery time for 134 athletes.
Their results showed that 40% of athletes recovered in one week, 60% in two weeks, 80% in three weeks, and 90% in four weeks. The authors concluded that there is a tremendous amount of variability in the time to a full functional recovery with this type of injury.
Coaches, administrators, parents, and athletes need to be educated as to the new research that is surfacing on concussions. The old days of getting your “bell rung” and continuing to compete while dazed need to be over.
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