If there is a hot-button topic in sports medicine today, it’s concussion and concussion awareness.
From professional leagues to youth sports, the past decade has seen a cultural shift in concussion awareness in sports. High-profile sports injuries have brought concussion to the forefront of people’s minds with the Centers for Disease Control and Prevention estimating that 1.6 million to 3.8 million Americans suffer a concussion from falls, sports activities and accidents each year.
Educating yourself about this serious brain injury and its potential dangers can lead to more prompt recognition if it happens to you or a loved one. Knowing the signs will help you avoid potential delay in evaluation and recovery.
Q: So what exactly is a concussion?
A: A concussion is typically a short-lived brain injury triggered by a hit or jolt to the head that causes mild, transient disturbance of brain function without loss of consciousness, and rarely causes brain swelling or permanent injury.
Q: What types of athletes typically tend to get concussions?
A: Although traditionally male athletes in contact sports like football, soccer, ice hockey and lacrosse get concussions, females who play similar sports like soccer and basketball can be at twice the risk of concussion when compared with their male counterparts.
When we consider the entire population, the most common causes for concussion are falls or motor vehicle accidents.
Young athletes may be more susceptible than adults to concussion and take longer to recover than adults, theoretically due to a larger head-to-body-size ratio, weaker neck muscles or increased vulnerability of the young brain to concussion.
Q: What is the standard treatment plan?
A: If someone is suspected of having a concussion, the most important thing is that they receive an immediate and thorough evaluation by a qualified healthcare provider experienced in the evaluation and management of head injuries and concussions.
We look for warning signs that raise the greatest concern, which can include severe headache, persistent vomiting, significant disorientation, lethargy, weakness, unusual behavior, slurred speech, unequal pupils, loss of consciousness, or waxing and waning consciousness. If any of these signs are present, the condition may be more severe than a concussion.
Typical concussion symptoms include headache, dizziness, nausea, neck discomfort, difficulty thinking clearly, trouble focusing on mental activities, disturbance of sleep patterns and mood changes.
Timely diagnosis and prompt treatment are crucial to help prevent more serious potential complications, including further brain trauma or a prolonged recovery. After diagnosis, a patient receives a standard set of instructions on managing his or her injury, including relative mental and physical rest. Any activity that provokes symptoms should be limited or avoided so as not to make the symptoms worse or potentially prolong recovery.
Q: What do you tell your patients about healing after a concussion?
A: After the initial injury, the body and brain require rest to recover appropriately. The key is avoiding or limiting symptom-provoking activities. These can include reading, texting, watching TV, playing video games, or doing any physical activity.
Athletes must be 100 percent symptom-free at rest and with exercise before returning to play. They must also pass a series of assessments before returning to their sport, to ensure normal neurocognitive measures.
School and homework can potentially worsen symptoms, so accommodations, such as increased time for assignments or test taking, should be negotiated with the school. Students may need to miss some school initially but are encouraged to attend school, even if for partial days, as long as their symptoms allow.
Q: How long does it take to recover from a concussion?
A: About 85 percent or more of concussion patients may return to play within three weeks after their symptoms began.
Ideally, we want the patient to be without symptoms for at least 24 hours before beginning a multiphase process of physical activity progression toward the goal of returning to play. This process may take several days, as patients often have symptoms that return with physical activity but resolve with rest.
Q: What kind of interventions do you use for those who are taking longer to recover than expected?
A: Medications may need to be taken for headache, neck pain, disordered sleep patterns or depression, as these conditions may hinder the recovery process. Physical therapy to treat neck pain, headache and dizziness is common for patients having persistent neck discomfort. Optometrists specializing in therapy for the eyes also can be beneficial.
Q: Why is concussion such a concern in sports?
A: We treat a lot of young athletes, whose brains are still developing. Although rare, the athlete who sustains a concussion and does not recognize the symptoms and sustains another hit to the head is at risk for a potentially catastrophic injury.
More commonly, athletes risk a much more symptomatic and prolonged recovery. And studies suggest that athletes with repetitive head trauma are at risk for chronic neurological symptoms.
All athletes who sustain a concussion must pass specific criteria before returning to play, including final clearance from their healthcare provider once they are completely asymptomatic after their injury.