Concussions - A Heads Up — Premier

Dr. Guido Zecca | August 26th, 2016

Fall and school are upon us, meaning time for sports. With this comes practice, games, and potential injuries. One of the more concerning issues that has come to the forefront in recent years is head injuries and concussions.

Concussions account for about 13-15% of all sports-related injuries that occur in high school athletes. A concussion occurs as a result of a direct blow to the head, face, or neck area, but can also be caused by a blow elsewhere on the body with force transmitted to the head. Concussions do not result in structural damage to the brain, rather a concussion is a disruption of function.

Symptoms of a concussion are typically brief, lasting several seconds, but symptoms may evolve over several minutes to hours. These include headache, confusion, disorientation, inattentiveness, difficulty with speech, vomiting, and trouble with balance.

When should you worry? What do you look for?

Most concussions are mild and people usually fully recover. There are instances when symptoms are more worrisome.

· Repeated vomiting

· Worsening headache

· Changes in behavior, such as irritability

· Seizures

· A definite loss of consciousness for longer than one minute

· Signs of a skull fracture (defect that you can feel on the skull)

· Vision changes

· An alteration in mental status that is persistent (worsening confusion or disorientation)

· Any neurological abnormalities (weakness or numbness affecting any of the extremities, problems with balance)

The presence of any of these signs or symptoms should prompt a visit to the Emergency Room for further evaluation.

Are certain injuries more worrisome?

High-speed bicycle crashes, diving injuries, falls greater than body height, or any high-impact head injury, particularly a mechanism that results in a “double hit” (struck on the head, followed by an impact with the ground or turf).

What role does a CT of the head play?

A CT scan of the head cannot “diagnose” a concussion, but it can rule out a more serious injury, such as bleeding in the brain, skull fracture, and swelling of the brain. Diagnosis of a concussion is based on clinical judgment and you can suffer a concussion without losing consciousness or being “knocked out”.

When can the athlete return to play?

No one should return to play if any signs or symptoms of a concussion are present. An athlete with a concussion should be medically evaluated by a healthcare professional to determine when they may return to sports.

The following is an example of the progression of activity for a return to play after a concussion:

1. Rest until asymptomatic (physical and mental rest)

2. Light aerobic exercise (e.g. stationary cycle)

3. Sport-specific exercise

4. Non-contact training drills (start light resistance training)

5. Full contact training after medical clearance

6. Return to competition (gameplay)

Many professional, collegiate, and school districts have their own programs and referrals in place for return to play and should be followed for the well-being of the athlete. Failure to follow these guidelines can lead to long-lasting symptoms and chronic conditions.

Premier hopes that you and your family have a safe and enjoyable fall season.