Sports Talk with Dr Joseph Norris – Concussion
With football season about to kickoff there is going to be a lot of high speed hard hitting action every weekend! As a football fan that is very exciting for me, but as a healthcare provider and someone who works a lot with athletes, I can’t help but be concerned for the safety of the players. It seems with every generation the athletes are getting bigger, stronger, and faster, consequently resulting in harder hits and more concussions. If you are a football player, coach, fan or parent of a football player, you have no doubt been aware of the recent studies in the past years about concussions and the consequences they can have long term on someone’s health. Concussions do not just happen in football, they can happen in any sport, but football seems to be among the top for frequency (6.4%). The purpose of this blog is to help educate players, coaches, and parents on what exactly a concussion is, and what the long term effects are, and when it is okay to return to play.
The medical definition of a concussion is: a clinical syndrome characterized by immediate and transient alteration in brain function, including alteration of mental status and level of consciousness, resulting from a mechanical force or trauma. Basically, a concussion is an injury to the brain that results in any temporary loss of normal brain function, which usually is the result of a direct blow to the head. As the head receives a violent blow or trauma, the brain which normally sits or floats in fluid, is violently "sloshed" around and bounces off the skull. This can result in tearing of blood vessels, stretching of nerve fibers, or bruising of the brain. And essentially that is what a concussion is, a bruise of the brain. Just like our knees or elbows bruise if we bang them, so does our brain. It is important to note that it does not always result in loss of consciousness (LOC). Many times people suffer concussions and do not lose consciousness.
The American Association of Neurology says according to the University of Pittsburgh’s Brain Trauma Research Center, more than 300,000 sports-related concussions occur annually in the United States, and the likelihood of suffering a concussion while playing a contact sport is estimated to be as high as 19 percent per year of play. More than 62,000 concussions are sustained each year in high school contact sports, and among college football players, 34 percent have had one concussion and 20 percent have endured multiple concussions. Concussions often cause significant and sustained neuropsychological impairments in information-processing speed, problem solving, planning, and memory, and these impairments are worse with multiple concussions. It is also estimated that between 4-20 percent of college and high school football players will sustain a brain injury over the course of one season. The risk of concussion in football is 3-6 times higher in players who have had a previous concussion. A study conducted by McGill University in Montreal found that 60 percent of college soccer players reported symptoms of a concussion at least once during the season. The study also revealed that concussion rates in soccer players were comparable to those in football. According to this study, athletes who suffered a concussion were 4-6 times more likely to suffer a second concussion.
Symptoms of concussion can be very vague or seem very minor but they should be taken very seriously. Diagnosis of a concussion is based a lot upon mechanism of injury and presence of a few specific symptoms. Confusion is a main symptom seen in concussions, and it has 3 distinct parts:
- Inability to maintain a coherent stream of though
- A disturbance of awareness and heightened distractibility
- Inability to carry-out a sequence of goal directed movements
Other common symptoms of a concussion are:
- Prolonged headache
- Vision changes
- Memory loss
- Impaired balance
- Sensitivity to light
There are several different ways to grade concussions and when the athlete should be allowed to return to play, but the Cantu Guidelines for return to play are most commonly used in the United States. Grading a concussion is based on 4 elements: 1.) Presence or absence of loss of consciousness 2.) Duration of loss of consciousness 3.) Duration of post-traumatic memory loss 4.) Persistence of symptoms, specifically headache, dizziness, nausea, and loss of concentration. The Cantu Guidelines outline the grade of concussion based on those elements, and based on that when it is safe for the athlete to return to play.
Cantu Return to Play Guidlines
Treatment for concussions is totally symptomatic. Tylenol or sometimes stronger medications occasionally are needed for headaches, but rest is the most important treatment. While trying to return to play the athlete should undergo a period of being symptom free for 24 hrs before beginning light exercise, like biking, jogging, etc. Then they may progress to more intense exercises like sprints, and sport specific drills, and ultimately back to practice. At anytime the athlete develops symptoms they must stop training and be symptom free for 24 hours before trying that activity again. Post-concussion symptoms like headache, nausea, dizziness, fatigue, and mood swings can last weeks to months before totally resolving, and it is very important to pay attention to these because returning to play with any of these symptoms could be very dangerous to the athlete and lead to what is known as Second Impact Syndrome.
Second Impact Syndrome results from acute and sometimes fatal brain swelling from a second concussion when an athlete returns to play too soon, and is not totally symptom free from the first concussion. It is thought that this causes swelling resulting in increased intracranial pressure, which occurs very rapidly and is very difficult if not impossible to control. That is why it is so important for players, coaches, parents, and healthcare providers to make sure that the athlete is not getting back to play too soon and putting them at serious risk for further injury.
Hopefully, this information is useful and helps educate players, parents, and coaches on what a concussion is and the risks associated with and what the appropriate guidelines should be for allowing the athlete to return to play. Anyone suspected of having a head injury should be evaluated by a medical professional. I hope everyone out there has a successful and safe football season.