Sports Concussions

helmetThe term concussion describes an injury to the brain resulting from an impact to the head. By definition, a concussion is not a life-threatening injury, but it can cause both short-term and long-term problems. A concussion results from a closed-head type of injury and does not include injuries in which there is bleeding under the skull or into the brain. Another type of brain injury must be present if bleeding is visible on a CT scan (CAT scan) of the brain.

  • A mild concussion may involve no loss of consciousness (feeling “dazed”) or a very brief loss of consciousness (being “knocked out”).
  • A severe concussion may involve prolonged loss of consciousness with a delayed return to normal.

A concussion used to be referred to as a “ding to the head” or “having your bell rung” and wasn’t taken seriously.  Today we know that a concussion is a type of Traumatic Brain Injury (TBI) that changes the way the brain normally works.  Even a mild bump to the head can be serious.

What Is A Concussion? 

A concussion is caused by a blow to the head or a jolt to the body such that the brain shakes within the skull.  In sports the blow can be from a fall or from an athlete colliding with another object – such as another player, a goal post, or the ground.  The impact doesn’t have to be directly to the skull; it can be to the upper body or part of the head, such as landing on one’s jaw.

What happens next is a chain of chemical changes within the brain.  These changes occur over hours and even days, which explains why often immediately after the impact the player might not seem so bad.  With any type of head injury, even mild, it’s essential that the athlete be removed from play and not returned that day.  If a player receives another hit to the head before the brain has a chance to heal, the results can be very serious – even causing death.  This is called Second Impact Syndrome. 

Signs And Symptoms

The following are signs to watch for:

Noticed by Others

  • Appears dazed or stunned
  • Is confused about assignment or position
  • Forgets an instruction
  • Is unsure of game, score, or opponent
  • Moves clumsily
  • Answers questions slowly
  • Loses consciousness (even briefly)
  • Shows mood, behaviour, or personality changes
  • Can’t recall events prior to hit or fall
  • Can’t recall events after hit or fall
Reported by Athlete

  • Headache or “pressure” in head
  • Nausea or vomiting
  • Balance problems or dizziness
  • Double or blurry vision
  • Sensitivity to light
  • Sensitivity to noise
  • Feeling sluggish, hazy, foggy, or groggy
  • Concentration or memory problems
  • Confusion
  • Does not “feel right” or is “feeling down”

What to Do If an Athlete Gets a Head Injury

Remove the athlete from play!  Do not try to diagnose on the sidelines.  Inform the player’s parents/guardian and seek a medical evaluation.  The concussed player should not resume physical activity until cleared by a medical professional trained in head injury management.

 When to Seek Medical Care for Concussion

Call a doctor about any of the following situations. The doctor will recommend home care, set up an appointment to see the affected individual, or send the person to a hospital’s emergency department.

  • A person struck a hard object with the head (for example: tile floor, ice, bathtub) but did not lose consciousness
  • Mild dizziness or nausea after a head injury
  • Loss of memory of the event (amnesia) for just a few minutes
  • Mild headache with no vision disturbances

Go to an emergency department by ambulance in the following situations. For people with less severe injuries not requiring ambulance transport, a car may be taken to the hospital.

  • Severe head trauma, for example, a fall from more than the height of the person or a hard fall onto a hard surface or object with resulting bleeding or laceration.
  • Any child that loses consciousness as the result of a head injury.
  • Prolonged loss of consciousness (longer than two minutes)
  • Any delayed loss of consciousness (for example, the injured person is knocked out only momentarily, then is awake and talking, then loses consciousness again)
  • Vomiting more than once
  • Confusion that does not go away quickly
  • Restlessness or agitation
  • Extreme drowsiness, weakness, or inability to walk
  • Severe headache
  • Loss of memory of the event (amnesia)
  • Perseverating (saying the same thing over and over)
  • Seizures or convulsions
  • Slurred speech
  • Someone who takes warfarin (Coumadin) or platelet inhibitors like clopidogrel or aspirin for a medical problem and suffers a significant blow to the head.
  • If the person fails to regain consciousness after two minutes, however, or the injury is very severe even if two minutes have not passed, DO NOT move the person. Prevent movement of the neck, which may exacerbate spinal injuries. If the person needs to vomit, carefully roll the person onto his or her side without turning the head. Call 911 immediately for help.helmet 2

If you are unsure of the severity of the injury, take the person to the emergency department immediately.

 Field Evaluationhelmet 1

  • Perform a Scene Survey. If the casualty was wearing a helmet, inspect the helmet for indications of how the impact occurred, and if it was shattered. This will help to evaluate the external forces applied to the head.
  • Assess ABCs – Airway, Breathing, Circulation
  • Assess normal neurologic function such as reflexes and mental status. (AVPU)
  • Examine the casualty for other associated injuries, such as a neck injury or whiplash, that are common with head injury.
  • Examine pupil response…dilated or unresponsive pupils are a bad sign.
  • Check vital signs such as pulse, respirations, and blood pressure…a slow and bounding pulse, reduced respirations, and increasing blood pressure are bad signs.
  • Inspect for bleeding from the ears or nose as well as bruising around the eyes or behind the ears that is commonly seen with certain types of fractures to the base of the skull.

Many times people are concerned about a laceration on the scalp or face. These cuts may bleed and appear serious, but severe or life-threatening bleeding from such a cut is rare and would be recognized right away. The main concern will be to assess that there is not serious brain damage, or a neck or torso injury. The cut can be repaired later.

The best way to evaluate a person’s head injury is with a CT scan. This machine takes cross-sectional X-rays of the head (or other body parts), and a computer reassembles the information into images to let the doctor see details of the inside of the body. When a CT scan is used for a head injury, a doctor will look for evidence of bleeding under the skull or within the brain tissue itself.

  • With less serious head trauma, a doctor may choose not to do a CT scan. A minor concussion can safely be observed either at home or in the hospital for 24-48 hours. If no other serious signs of injury develop, the person will usually be safe.
  • Skull X-rays are no longer routinely used to evaluate a person with a concussion.
  • A concussion may be accompanied by a skull fracture. The patient may still have a skull fracture even though a doctor does not perform a CT scan or take X-rays. This is acceptable. The presence of a fracture does not, alone, increase the likelihood of an injury to the brain unless there are also other signs of head injury.
    • Skull fractures almost always heal well. Casts are not used on the head.
    • In rare cases, a leptomeningeal cyst may form. These are bulges of the bone and tissue at the site of the fracture, which develop months later. There is no way to predict their occurrence or to prevent them.
    • If the patient notices a bump forming months after a head injury, X-rays of the skull may be done at that time, and if there is a leptomeningeal cyst forming, the patient will be referred to a neurosurgeon for evaluation and treatment.

 Concussion Facts

  • Athletes who have had a concussion are at increased risk for another concussion.
  • Children and teens are more likely to get a concussion and take longer to recover than adults.

Myths vs. Reality

  • You need to be knocked out for it to be a concussion.  Most concussions do not result in a loss of consciousness, or blacking out. 
  • You cannot let a person with a concussion fall asleep.  We now know that the absolute best thing for the injured brain is rest.  Since your brain is used to process information from all your senses, “brain rest” means cutting back on every day activities such as watching TV, reading, video gaming, and using a cell phone.
  • My child needs a brain scan to diagnose a concussion.  The brain changes from a concussion cannot be picked-up by a scan.  Your doctor will determine if your child’s symptoms indicate the need for a brain scan, such as an MRI or CT, to determine the extent of the injury.   
  • An expensive helmet will prevent a concussion.  While a good quality helmet can help lessen the chances of a skull fracture, a helmet will do nothing to prevent the shaking of the brain inside the skull during a concussion.  In fact, some players feel overly confident with an expensive helmet and use the head against another player.  The head should never be used as a weapon and many sports are banning head-to-head hits.
  • If I report my concussion, I’ll never be able to play contact sports again.  It’s essential that a concussion be reported to your coach, family, and doctors.  Steps will be taken to allow your brain to heal.  Depending on the severity, most athletes recover fully from a concussion and can resume playing.

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