The definition of a concussion is a traumatic brain injury that results in a temporary disruption of normal brain function. A concussion can also be referred to as a traumatic brain injury (TBI) or closed head injury. This injury can present with a variety of signs, symptoms and behaviors. When diagnosing, treating and making decisions regarding a return to athletic activity for an athlete with a suspected concussion, the medical professional should be familiar with the following signs, symptoms and behaviors of a concussion:
Frequently, in the case of sports concussion, there is no loss of consciousness, so the remaining signs and symptoms come to play a greater role in cases of suspected trauma. With the increasing attention paid to sports concussions in the media, athletes have learned the “right answers” to give to questions asked of them by evaluating medical professionals in order that they might prevent themselves from being sidelined. It is critically important, then, for the medical professional to complete a thorough evaluation before allowing an athlete to return to action to insure the athlete’s safety.
For most athletes, going through a concussion can be a really a challenging period of time; they may not display any visible signs or symptoms of the injury, there is no bandage or crutch that they must use to aid with his or her injury. A concussion is often labeled as an “invisible injury.” This label can often lead to returning athletes back to play before they are ready.
A concussion can happen in any sport. A concussion can be sustained by taking a direct blow to the head. An athlete can also sustain a concussion by taking a blow to the body that causes the brain to shake in the skull. An athlete can fall on their bottom and the resulting force can be transmitted through their body and to the brain, causing a concussion. Concussions can be sustained in a car wreck, as well. An athlete who sustains a concussion off of the field, therefore, must be cleared from the injury before return to play.
Participating in sports/activities while still healing from a concussion is a potentially dangerous situation. In the past, an athlete sustaining a concussion would have been told to “shake it off” and “get back into the game.” A concussion has also been referred to as a “ding” or “having their bell rung;” concussions are more serious than this and these terms should not be used. Continuing to play with symptoms of a head injury can leave an athlete vulnerable to further substantial injury or even death. Making a return-to-play decision should be done with great care. The medical professional making the return to play decision is liable for the health and safety of the concussed athlete.
Concussion education and prevention are the two best ways to protect our athletes from the devastating effects of concussions. Educating area coaches and informing parents at preseason meetings are vital for keeping our athletes safe. Concussion prevention is also very important. There are several ways to prevent concussions, including: following rules specific designed for safety, practicing good sportsmanship, and using proper equipment every time. Proper equipment should be sport and position specific. The equipment should fit well and be worn correctly. Inspections for damaged or defective equipment should be done daily.
Second Impact Syndrome (SIS) is a serious condition that can result from returning an athlete back to play too soon. This syndrome is a rare condition in which an athlete sustains another concussion before the first concussion has completely healed. In SIS, the second injury causes rapid and severe brain swelling that can result in death. SIS can result from a very minor incident occurring days, weeks or even months after the initial concussion. Severe signs and symptoms are associated with Second Impact Syndrome such as: dilated pupils, loss of eye movement, unconsciousness, respiratory failure and even death.
Determining when it is safe to return to play from a concussion is a highly debated issue. There are several models that make clear suggestions for return-to-play. As a medical community, it has been suggested that the medical professionals try to agree on a common protocol to follow and be consistent in following that protocol. A multi-disciplinary team includes doctors, nurses, nurse-practioners, certified athletic trainers and any other allied health professional that may be involved in making return to play decisions for athletes. For athletes participating in sports where concussions are possible, a baseline measurement test should be taken prior to the first day of practice. This baseline can be used to determine the severity of a sustained concussion and aid in return- to-play decisions.
If an athlete sustains a concussion or a concussion is suspected during a practice session or a game, the athlete should be removed from the activity immediately. The athlete should not return to the sport the same day of a concussion. The athlete should be monitored closely for the next 24 hours to watch for any worsening signs or symptoms that may indicate a more severe injury. Once the athlete is symptom free, the athlete should then be reassessed to determine if cognition and postural stability have return to baseline levels.
Baxter Regional Medical Center’s Sports Medicine utilizes a protocol that is followed by the certified athletic trainer. The return-to-play protocol used is based on incremental, sports-specific challenges over a four-day period. If the athlete begins to demonstrate signs or symptoms of concussion during the testing, the test is stopped and the same phase will be attempted the next day. The first day of return-to-play testing should include a cardiovascular challenge. The athlete can participate in treadmill running or stationary biking. The purpose of this challenge is to elevate the heart rate and monitor for increasing signs or symptoms of concussion. If the first phase is passed with no symptoms, the second phase can be administered the next day. There must be 24 hours in between each of the four challenges. The second challenge is agility training. The athlete should perform running, cutting and jumping drills specific to their sport. The medical professional should monitor for any increase in signs or symptoms of concussion during this test. The third phase of testing involves sports specific-drills; for instance, a basketball player could do lay-ups or shooting drills. All of these drills should be non-contact in nature. The final stage of returning to play should include full contact drills. The athlete can complete sports specific drills that put them in live situations. The athlete should be re-tested every 5-10 minutes to insure no signs or symptoms of concussion are returning. It is important that the athlete has been symptom free for seven days prior to full return-to-play. However, this return-to-play protocol can be started during those seven days. This waiting period is vital in preventing Second Impact Syndrome, which may have deadly consequences.
Works Cited
Guskiewicz, Kevin M., Scott B. Bruce, Robert C. Cantu, Michael S. Ferrara, James P. Kelly, Michael McCrea, Margot Putukian, and Tamara C. Valovich McLeod. "National Athletic Trainers' Association Position Statement: Management of Sport Related Concussion." Journal of Athletic Training 39.3 (2004): 280-97. Print.
Jeff Miller National Football League. NFL and the NATA Team to Pass State Laws to Protect Youth Athletes From the Risks of Concussions. Www.nata.org. National Athletic Trainers Association, 07 Dec. 2010. Web. 14 Mar. 2011. <http://www.nata.org/print/NR120710>.
Solomon, PhD, Gary S., Karen M. Johnston, MD, PhD, and Mark R. Lovell, PhD. The
Heads-Up on Sports Concussion. Champaign, IL: Human Kinetics, 2006. Print.