SPORTS
by Charlotte Moriarty, MD, PhD, CAQSM
Head injuries in sports are quite common and should always be taken seriously. The most common head injury in sports is a concussion. Concussion represents 8.9% of all high school athletic injuries and 5.8% of collegiate athletic injuries. A concussion is generally defined as a trauma-induced alteration in mental status due to brain injury that may or may not involve a loss of consciousness. In fact, 90% or more of concussions do not involve a loss of consciousness. Concussions can be caused either by a direct blow to the head and face, or by transmitted forces from contact to another part of the body. A concussion is a functional disturbance of the brain, as opposed to a structural injury. No abnormalities are seen in standard imaging studies (including CT scan) and imaging is often not necessary.
Sports concussions can present a difficult situation due to the athlete’s desire to return to play, coaches’ desire to have their athletes available, and the social pressure of parents, the media, and college scouts. Due to the potential sequelae of injury, it is important to identify concussions early and remove the athlete from play to prevent further injury.
Concussion symptoms may include but are not limited to headache, blurry vision, fogginess, drowsiness, nausea, sensitivity to light, sensitivity to noise, and emotional lability. Athletes may exhibit delayed reaction times, irritability, anxiety, and a depressed mood. In some cases, the symptoms may not appear until several hours after the injury or until the following day.
The majority of concussions (80%-90%) resolve quickly, usually within 7-10 days. Due to incomplete brain development, children and adolescents are susceptible to an extended resolution period. When concussion symptoms persist beyond 30 days, an athlete is said to have post-concussion syndrome.
While specific guidelines for concussions may differ among organizations, the following statements are generally agreed upon:
• No athlete should return to play on the day of injury.
• No athlete should return to play while any symptoms are still present either at rest or with exertion.
• The safest maxim in the face of any uncertainty is “when in doubt, sit them out.”
• Frequent reevaluation and serial examination are absolutely mandatory. It is recommended that these examinations are conducted by a physician with experience in sports medicine and management of sports concussion.
The main tenet of treatment for concussion is physical and cognitive rest. Complete physical rest is mandatory until all symptoms have resolved. Any activities that involve concentration and attention, including schoolwork, video games, and texting, have the potential to exacerbate symptoms and delay recovery. Academic schedules may have to be modified for student athletes until symptoms subside. With complete rest, the majority of symptoms will resolve spontaneously within several days. Athletes with a history of prior concussion should be given more time to recover.
When symptoms have resolved, the next step is a supervised gradual return to physical activity. The graduated return-to-play protocol walks athletes through six stages to safely return athletes back to full, unrestricted play. The athlete needs to remain asymptomatic to continue through the stepwise progression. Each stage should last a minimum of 24 hours. Thus, if a football player sustains a concussion in a Friday night game and is asymptomatic on Sunday morning, he will inevitably miss the following week’s Friday night game as he cannot safely complete the progression within this time period.
A rare phenomenon called “second impact syndrome” is one reason for the graduated return to play. This occurs in an athlete who returns to contact before concussion resolution. A second traumatic event results in immediate, uncontrollable swelling of the brain. This leads to death in nearly 100% of cases. While rare, prevention of second impact syndrome is accomplished by strict adherence to return to play guidelines.
Even in athletes with uncomplicated recoveries, we do not yet understand what the potential long term consequences of concussion may be. The best way to protect our young athletes is to prevent concussions when possible through minimizing contact in our youth athletes, teaching correct technique (tackling in football, checking in hockey, and heading in soccer), and identifing concussions early on to ensure they are managed appropriately. And remember, when in doubt, sit them out!
For more information regarding sports concussions, please visit:
https://www.cdc.gov/headsup/index.html
https://www.stopsportsinjuries.org/STOP/STOP/Prevent_Injuries/Concussion.aspx
Dr. Moriarty will be speaking about Sports Concussion at South Kingstown High School on Wednesday, September 26, 2018 at 6:30 pm. Please stay tuned for more information.
