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Recognizing Concussion Symptoms in Athletes

It feels like during just about every NFL or college football game that you watch lately there is a player going off to the sidelines for a concussion evaluation—the tent goes up and after a few minutes they come out and the player either goes to the locker room or back to the field. Most people have heard the long discussion about the risks of concussion, CTE and how to make the game safer. But how many people actually could recognize a concussion or even know that girls are more likely than boys to get a concussion?

What is a concussion?

A concussion is a mild traumatic brain injury that effects the brains overall function. Think of it like a bruise on the brain, which is why the vast majority of concussion show no changes on CT scan or MRI.

The brain is suspended in the skull in a fluid (called Cerebrospinal fluid) that creates a cushion around the brain. A concussion is caused by a blow to the head that is too hard for the cerebral spinal fluid to stop the brain from bumping up against the inside of the skull causing a bruise. That blow can be caused by a direct hit to the head, the head bouncing off the ground or a violent shaking of the head and upper body. The violent head shaking or head bouncing off the floor is increased when the athlete’s neck is not strong enough to slow the head as they fall to the ground or shake. Studies show that girls’ neck strength is not as developed as the corresponding boys their age in sports that are played by both boys and girls—thus the higher risk of concussions in girls. While girls have a higher incidence of concussion, they also seem to demonstrate a more rapid recovery from their symptoms.

Signs and Symptoms of Concussions?

Concussion symptoms usually occur within minutes of the injury, but can progress and worsen for a few hours to a couple days. Concussion symptoms vary in intensity and frequency between individuals.

The most common symptoms of a concussion is a headache, but athletes may also display the following symptoms:

  • Loss of consciousness
  • Feeling in a “fog”
  • Difficulty remembering
  • Nausea/vomiting
  • Difficulty with Balance
  • Pupils that are enlarged or unequal in size
  • Double or Blurred vision
  • Slurred Speech
  • Difficulty Falling asleep
  • Excessive Drowsiness
  • Behavioral Changes (irritability, rapid mood changes, exaggerated emotions, aggressiveness, decreased tolerance to stress, and many more)
  • Headache or pressure

What to do if You Suspect a Concussion:

  • DO NOT ALLOW THEM TO RETURN TO SPORT until they are cleared by a physician who has completed advanced training in concussions.
  • Allow the concussed person to REST. Rest involves frequent naps and avoiding distractions such as television, reading, video games, the internet, social media until allowed by your physician. (There was a theory that they should be kept in a dark room and not allowed any distractions, but that theory has changed, but still includes neurocognitive rest for at least 48 hours).
  • There is NO need to wake the concussed person up every hour—in fact that interferes with sleep patterns and slows brain healing.
  • DO NOT leave the concussed person alone, as their symptoms need to be monitored.
  • If someone loses consciousness, they MUST be evaluated for a spine injury.
  • Go to an emergency room if any of the following occur:
  • Repeated vomiting
  • Loss of consciousness greater than 30 seconds
  • A headache that is worsening over time
  • Continued behavioral changes
  • Worsening physical conditions, such as clumbsiness
  • Disorientation/Confusion
  • Slurred speech
  • Seizures
  • Visual disturbances
  • Any Symptoms worsen over time.

So, Why are concussions and concussion-care such a big deal?

If concussions are not properly cared for there are several potential complications that can have long lasting effects, such as:

  • Post-traumatic Headaches can last a few weeks to a few months
  • Post-traumatic vertigo is spinning or dizziness that may last for days, weeks or months and can greatly effect function.
  • Post-concussion syndrome is symptoms that can come back multiple times in the successive months following a concussion.
  • Cumulative effects of multiple brain injuries may lead to long term effects that are possibly progressive and permanent. (This is the area of research that so many sports news and mainstream newscasts concentrate on). Possible future issues my include CTE (chronic traumatic encephalopathy, which is a long term swelling of the brain which has been linked to depression, chronic attitude changes and even suicide), Parkinson’s, full traumatic brain injuries and even death.
  • Second Impact Syndrome is a second concussion before the first concussion is resolved. Second impact syndrome results in rapid and FATAL brain swelling.

With all these complications to be aware of, how should a concussion be cared for?

There are multiple steps to caring for someone after a concussion. There is some discrepancies in the research, but if it were me or my child, I would recommend a comprehensive recovery protocol that leans toward the conservative side.

A comprehensive plan should include NEVER continuing in that game, a full evaluation by an advanced trained physician (specifically Impact trained), 48 hours of neurocognitive rest followed by a progressive exertional protocol by an athletic trainer or physical therapist who is trained in concussion before any return to activity can be considered. Once the exertional protocol and return to play protocol is completed and the concussed individual has begun practicing without contact without ANY symptoms, a physician must clear the athlete for full return to play.

Upon return to play, the athlete must be watched carefully to assure no symptoms return.

The issue with athletes is that from a young age they are taught to do any and everything to play, so they tend to downplay injuries. With this in mind, parents, coaches, teachers and medical professionals must keep a diligent watch out for concussion symptoms and investigate as necessary. It is the highest responsibility of parents, coaches, teachers and medical professionals to protect our children/athletes from themselves.