Concussions in Sports
WHAT IS A CONCUSSION?
Concussions are a surprisingly common occurrence in sports. High school athletes suffer thousands of concussions every year, most often in football, ice hockey, and soccer. Concussions do not always involve being "knocked out," or a loss of consciousness. A concussion occurs whenever a child's mental status changes as a result of trauma (usually a blow to the head). A child who shows signs of mental confusion or is "dinged" by a blow to the head has suffered a concussion.
WHAT HAPPENS AFTER A SPORTS-RELATED CONCUSSION
Sports-related concussions often result in mental and physical symptoms (e.g., inability to concentrate, forgetfulness, headache, fatigue, dizziness). For many athletes, the symptoms disappear after about 10 days, and they typically do not last more than several months. In some cases, though, concussions lead to persistent complaints of physical, mental, emotional, and behavioral symptoms, sometimes referred to as post-concussion syndrome. We do not know whether persistent post-concussive symptoms result from primarily medical or psychological causes. In rare cases, when repeated concussions occur over a brief interval, athletes may suffer from second impact syndrome, a pathological response of the brain that can be life-threatening if not treated promptly. Parents should seek careful evaluation and management of any sports-related concussion.
HOW SHOULD A SPORTS-RELATED CONCUSSION BE EVALUATED?
Concussions are typically managed according to their severity. Immediately after a concussion, medical evaluation is needed to determine a child's vital signs and level of consciousness and to rule out any other injuries, such as those to the spine. Recent guidelines indicate that any child who loses consciousness as a result of trauma during a sporting event should be evaluated by a hospital emergency department. In cases of less severe concussion, athletes are typically evaluated on site rather than in hospital emergency departments. There are a variety of approaches to the "sideline" assessment of concussion. Guidelines are also available to assist in deciding when a child is ready to return to play after a concussion.
CAN NEUROPSYCHOLOGICAL ASSESSMENT HELP?
Neuropsychological assessment is widely regarded as the most sensitive way of detecting disturbances in brain function associated with concussion. The National Football League and the National Hockey League have both instituted systematic programs of neuropsychological testing, as have many colleges. Athletes are administered brief tests of attention, memory, and speed of information processing before the season. Athletes who sustain concussions are tested again, typically within 48 hours of the injury and at regular intervals afterward. Recovery to baseline levels of performance is typically required before athletes are allowed to return to play. Similar cooperative programs can be instituted for organized athletic programs at the high school level. In the absence of programmatic testing, athletes who complain of persistent post-concussive symptoms should be considered for a more comprehensive neuropsychological evaluation.
WHAT CAN BE DONE TO PREVENT OR TREAT CONCUSSIONS?
Changes in the rules for athletic competition have reduced the number of sports-related concussions. After the National Collegiate Athletic Association made the use of the head when tackling illegal in 1976, the annual number of head and neck injuries in football declined by about 50%. The required use of helmets in many contact sports and advances in helmet design also has resulted in fewer head injuries. Improved conditioning of young athletes, especially strengthening of neck muscles, may also help to prevent concussions.
If a child sustains a concussion, parents should seek appropriate medical care. They should request a description of symptoms indicative of worsening brain injury and of common post-concussive symptoms, as well as guidelines for return to play and for medical follow-up. For athletes who experience persistent difficulties after a concussion such as headaches, difficulty concentrating, irritability, sleep disturbances, or dropping grades, an effective treatment plan will often combine education, cognitive rehabilitation, psychological support, and in some cases medication.
Consult your primary care physician for more serious injuries that do not respond to basic first aid. As an added resource, the staff at Nationwide Children’s Hospital Sports Medicine is available to diagnose and treatsports-related injuries for youth or adolescent athletes. Services are now available in five locations. To make an appointment, call (614) 355-6000 or request an appointment online.
en españolLos deportes y las conmociones cerebrales
If you play sports or follow professional or college teams, you probably know that concussions are a serious issue. Playing sports increases a person's risk of falls and collisions with objects or other players. These can cause concussions — a type of brain injury. That's true of all sports, not just contact sports like football and hockey.
As long as people play sports, there will be concussions from time to time. But wearing the right protective gear and playing the right way can make a brain injury less likely.
If you do get a concussion, take a break from sports. Making sure you let your brain heal completely helps prevent long-term problems.
How Do Concussions Happen?
The brain is soft. The body protects it by cushioning it in cerebrospinal fluid inside a hard skull. Because the brain floats in the fluid, it can move around and even bang against the skull.
A fall or collision that makes the brain bang against the skull can bruise the brain. It also can tear blood vessels and injure nerves. These injuries can cause a concussion — a temporary loss of normal brain function.
There are lots of ways concussions can happen in sports, such as:
- helmet-to-helmet tackles in football
- getting checked against the boards in hockey
- heading a ball incorrectly in soccer
- skateboarding or biking wipeouts
- collisions between skiers or snowboarders
How Can I Prevent a Sports Concussion?
Start With the Right Equipment
Everyone should wear properly fitting, sport-appropriate headgear and safety equipment when playing contact sports or biking, rollerblading, skateboarding, snowboarding, or skiing. You can't prevent every concussion. But helmets, mouthguards, and other safety gear can reduce the risk of a brain injury.
Play it Safe
Headgear is your first line of defense. But you can still get a concussion because helmets don't stop injury from happening on the inside. If you hit your head, your brain can still bang against your skull, even if you're wearing a helmet.
Don't take chances because you think your headgear protects you. This is one reason why there are rules in sports. Learning the right technique and developing the skill to avoid dangerous plays can make all kinds of injuries less likely to happen.
What if I Have a Head Injury?
If you hurt your head while playing a sport, stop playing immediately. A coach should know to take you off the field. But if you don't have a coach, or your coach doesn't pull you from play, take yourself out of the game.
If you're skiing or snowboarding, get the ski patrol to help you down the hill. If you're skateboarding or biking, stop riding. Don't take a chance on hurting your head again. A second head injury can lead to a condition called second-impact syndrome. Second-impact syndrome doesn't happen very often, but it can cause lasting brain damage and even death.
If you hurt your head playing organized sports, a coach or athletic trainer may examine you right after your injury. This is known as sideline testing because it might happen on the sidelines during a game. Sideline testing is common in schools and sports leagues. By watching you and doing a few simple tests, a trained person can see if you need medical care.
Lots of schools or sports leagues test players at the start of a sports season to measure their normal brain function. These tests are called baseline concussion tests. Coaches, trainers, or doctors often compare these baseline results against sideline tests to see if a player's brain is working OK.
What Are the Signs of a Concussion?
If you were playing a sport and banged your head but didn't see a doctor when it happened, be alert for signs of a concussion. Concussions don't always show up right away. It can take up to 3 days for signs to become obvious.
See a doctor as soon as you can if think you might have a concussion and develop any of these problems:
- feeling sick or throwing up
- difficulty with coordination or balance
- blurred vision
- slurred speech or saying things that don't make sense
- feeling confused and dazed
- difficulty concentrating, thinking, or making decisions
- trouble remembering things
- feeling sleepy
- having trouble falling asleep
- sleeping more or less than usual
- feeling anxious or irritable for no apparent reason
- feeling sad or more emotional than usual
When Can I Return to Play After a Concussion?
The #1 question athletes ask after a concussion is how soon they can start playing again. The answer is simple: When a doctor tells you it's OK.
Concussions can be tricky: You might feel fine, but your thinking, behavior, and/or balance may not be back to normal. Only a doctor can tell these things for sure.
It's essential to wait until the doctor says it's safe to return to sports. But people sometimes feel pressure to start playing again — they worry about letting down the team or they feel pushed by a coach. That's one reason why most U.S. states have rules about when kids and teens can start playing sports again after a concussion. These rules are there to protect players so they're not pushed into getting back in the game too soon — when the risk of re-injury is high.
There are a number of ways doctors can tell if someone is ready to return to play. A doctor will consider you healed when:
- the signs and symptoms of concussion are gone
- you regain all of your memory and concentration
- you don't have symptoms after jogging, sprinting, sit-ups, or push-ups
When your doctor gives you the OK to start playing sports again, ease back into things. Stop playing right away if any symptoms return (that second-impact syndrome thing again). With the right diagnosis and treatment, most teens with concussions recover within a week or two without lasting health problems.