Concussions 101: Learn the Basics
Karla L. Robinson, MD
With all of this talk about concussions in the NFL and NHL, many are wondering why there is so much media frenzy. A lot of contact sport fans feel like big hits are just a part of the game, and can’t understand why there is so much concern now. Yes, football has always been a “violent” contact sport, with lots of big hits, but now we are finding out that these are not without consequences.
Is this a common problem?
Some estimate that over 250,000 documented sports related concussions occur every year. It is thought that 20-25% of all high school football players experience a concussion in a season. These are just the ones that have been diagnosed. It is feared that many don’t realize the signs and symptoms of concussions and that these numbers are a significant underestimate of the actual frequency of the injuries.
What is a concussion?
A concussion is a traumatic brain injury resulting from a blow to the head. Its severity can vary. Concussions are graded on a scale from 1 to 3. A mild concussion or Grade 1 injury may be commonly described as “having your bell rung” or being “dazed” after a hit to the head, but it is a concussion none the less. We tend to pass these sorts of injuries off as “normal” and inappropriately continue play. A more severe concussion, as in a Grade 2 or 3 may be accompanied by altered mental status symptoms lasting longer than 15 minutes after the injury, or being “knocked out” and experiencing an actual loss of consciousness.
It’s important to note that despite popular belief, less than 10% of all concussions are associated with an actual loss of consciousness. It’s necessary to recognize the signs, so a potentially dangerous injury is not overlooked.
What are the symptoms?
Some acute symptoms of a concussion may be momentary confusion, headache, visual changes, nausea or vomiting, a loss of coordination or a staggering gait, memory trouble, or tinnitus (ringing in the ears). These symptoms commonly occur immediately following a concussion or may not occur until a few hours after the impact. Therefore it is important to observe anyone who has experienced any type of head injury, even if initially they don’t have many symptoms.
Some concussion injuries are severe enough to cause some chronic symptoms lasting days, weeks, or longer after the initial injury. These manifestations may include fatigue, irritability, headaches, balance and coordination difficulty, depression and/or anxiety, sleep disturbances, difficulty with concentration and decision making, and confusion. This may be a sign of Post Concussion Syndrome and requires further testing and a specialist’s evaluation.
What is the treatment?
Most concussions resolve with no specific treatment and no lasting complications. The most important treatment for concussions is rest and observation, and allowing sufficient time to heal. In sports, this means removing the injured player from play immediately, even if they think they are ok to play. Sometimes, it’s actually post-concussion memory loss and they may not remember that they just experienced a head injury. Rushing back to play without giving the brain time to heal may lead to serious consequences. Second Impact Syndrome can result if another head injury occurs prior to the complete resolution of the first concussion. This can cause swelling in the brain and can lead to death. This is sadly seen in players who have returned to contact sports too quickly and sustain another blow to the head.
More severe concussions or those with a loss of consciousness, changes in behavior or cognitive abilities, or any residual symptoms lasting longer than an hour should always involve a medical examination by a physician, and neuropsychological testing. There should be sufficient and frequent follow up in the days, weeks, and months to follow to ensure complete resolution.
What if it happens more than once?
The number of concussions sustained also plays a role in the long term loss of functioning. The damage can often time be cumulative, leading to a permanent decline in functioning and lasting psychological problems. In addition to multiple specialist referrals, sometimes medication is needed to treat the physical and behavioral problems that may remain.
What can we do?
Our goal is for everyone to know what a concussion looks like and sounds like. So whether you are an occasional flag football participant in games that just may get a little rough sometimes, or if you are a coach of a teen contact sport, you need to know what to watch for.
If after a blow to the head there is confusion, repetition of words or phrases, memory loss, or staggering of any sort, regardless of whether there was an actual loss of consciousness or not, this is a concussion and should be treated as such. Please don’t ignore the signs. Let’s play it safe.