Terms used to describe things that happen in the sporting world can be quite interesting. We have all heard the terms, “you got your bell rung”, “he took a head shot” to describe what is medically referred to as a concussion or traumatic brain injury (TBI). A concussion or TBI occurs when the brain moves violently in the skull due to an external force such as head to head contact or head to ground contact, resulting in temporary loss of normal brain function. Damage to the brain occurs both from the initial direct trauma and sheering forces and also via the swelling that occurs due to the trauma.
Although often times taken lightly, these seemingly benign injuries can have devastating consequences if not recognized early. As we enter into the fall sport season the incidence of these injuries increases dramatically and some statistics are quite alarming. So be alert and don’t let your child or player become a statistic.
Traumatic Brain Injury is the leading cause of death in children and young adults with 21% occurring during sport or recreational activities. TBI kills more Americans under the age of 34 than all other factors combined. Research is finding that even relatively mild concussions can have serious, long-term effects, such as cognitive impairments and depression especially repeat head injuries or cumulative concussions. So the big question becomes, “when can and should the player return to play following a TBI or concussion?
Although preventive measures such as proper headgear and educating athletes in proper execution/technique reduce the risk, concussions in sports will still occur. Recognition of an athlete that has sustained a concussion is critical and often times noticed too late as athletes often times deny one has occurred or a coach or parent puts the outcome of the game before the safety of the player.
Second impact syndrome occurs when an athlete continues or returns too early after suffering an initial concussion and the brain has not healed completely. The chance of death or serious brain injury is greatly increased and the second blow to the head does not need to be a violent one for additional injury to occur. Educating athletes, parents and coaches is critical to prevent Second Impact Syndrome.
Symptoms of a concussion or TBI include; headache, nausea and/or vomiting, dizziness or balance problems, blurry vision, sensitivity to light or noise, feeling sluggish, hazy or groggy, memory and concentration problems, and confusion. Signs that the coach or parent may observe are the player appears dazed or stunned, confused about assignment or position, forgets plays, unsure of game/opponent/score, moves clumsily, answers questions slowly, shows behavior or personality changes, can’t recall events prior to or after the hit or fall, and or loss of consciousness.
Concussions are graded with various methods and similar guidelines. Concussions are graded from Mild (Grade 1), Moderate (Grade II) and Severe (Grade III). This classification is based on a combination physical testing and questions to the player regarding orientation, concentration and memory recall. In basic terms, a mild concussion or Grade I results in symptoms lasting less than 15 minutes with no loss of consciousness. Grade II is classified by symptoms lasting longer than 15 minutes with no loss of consciousness. Grade III is any loss of consciousness (LOC) and can be sub-classified into Brief LOC for seconds and Prolonged (LOC) lasting greater than 1 minute. Return to play guidelines allow a player to return to play same day with Grade I concussion if all symptoms clear. Guidelines suggest one-week off and symptom free for Grade II, and two-weeks off and symptom free for Grade III. Athletes sustaining two Grade III concussions require one-month off and symptom free. Tests such as the ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing) are also recommended to determine an athlete’s readiness for return to play. This test is administered to athletes prior to participation in sports to develop a baseline of brain function and then performed following any head trauma to determine how well the brain has healed.
These guidelines are relatively safe and supported by research. However, some states such as Washington have enacted legislation that address the seriousness of concussion. Washington’s Lystedt Law passed in 2009 following the TBI of Zachery Lystedt during a middle school football game contains three essential elements or requirements;
All athletes, parents and coaches must be educated about the dangers of concussions each year.
A licensed health care professional must clear any athlete for return to play following concussion.
(The most Important) IF A YOUNG ATHLETE IS SUSPECTED OF HAVING A CONCUSSION, HE/SHE MUST BE REMOVED FROM THE GAME OR PRACTICE AND NOT BE PERMITTED TO RETURN TO PLAY THAT DAY AND UNTIL CLEARED BY A HEALTH CARE PROFESSIONAL.
Conclusion; Remember the winning of a game is not worth the loss of a life or brain of any child. When in doubt, sit them out.
For information on other topics visit our website; progressive-pt.net
Bucky Whiteman, MBAPTProgressive Physical Therapy & Rehabilitation Center