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Concussions

By Lynne Young, M.Ed., ATC

Did You Know that Concussions Are Brain Injuries?

There are more than 3.8 million sports and recreation-related concussions in the United States each year. In the past, people have called them “dings,” “stingers,” or “getting your bell rung.” These names downplay the effects of concussions, minimizing what they really are — brain injuries — and have needlessly put a large number of our kids in serious danger.

Current medical studies indicate that brain injuries by any name necessitate a more thorough medical evaluation and conservative management plan. The best-case scenario for return to play following a brain injury (even if signs and symptoms clear within minutes) is seven to ten days, which I will discuss later in this article.

What exactly is a concussion?

Concussions are traumatic brain injuries. They can be caused by bumps, blows, or contact to the head. They can also be caused by blows to the body, falls, or collisions with people or obstacles or anything that causes the brain to move rapidly inside the skull.

Football, hockey, and soccer are among the higher-risk sports we see here in Alaska, but concussions can occur during any form of activity that may involve a fall or collision. 

What are the symptoms? 

Most concussions do not result in a loss of consciousness. Recognition and proper response can assist in preventing further injury or even death. There are many signs and symptoms that may be observed with potential concussions. The most common symptoms after a traumatic brain injury (concussion) are headache, dizziness, memory loss, and confusion. Concussion symptoms range from immediate onset to a delay of hours or even days.

These are SOME of the signs and symptoms to look for:

Signs Observed
  • Appears dazed/stunned
  • Confused
  • Forgetful
  • Unsure of surroundings
  • Clumsy/Balance difficulty
  • Answers slowly
  • Loses consciousness
  • Behavior/mood changes
  • Cannot recall events before
  • Cannot recall events after
  • Slurred speech
  • Fatigue
Symptoms Reported by the Athlete 
  • Headache/Pressure
  • Nausea
  • Vomiting
  • Balance difficulty
  • Dizziness
  • Vision problems
  • Light sensitivity
  • Noise sensitivity
  • Feeling sluggish, foggy
  • Does not "feel right"
  • Confused
  • Cannot concentrate

The signs and symptoms of a concussion can be subtle and may not be immediately apparent. Signs and symptoms can last for minutes, days, weeks, months, or even longer.

How do you treat a concussion?

Individuals who experience any signs or symptoms after a bump or blow should be kept out of play — whether it’s practice or competition — for the remainder of the day. They should remain out of play until medically evaluated by an appropriate health care provider. A repeat concussion before the brain recovers fully from the first injury can slow the recovery process, increase the risk for long-term problems, or even result in death from second-impact syndrome. Rest is key to assisting individuals in their recovery. Exercise or activities that involve concentration (studying, computer work, texting, video games) may cause concussion symptoms to get worse.

When can I play again?

Following a concussion, individuals should participate in a gradual return-to-play protocol that is managed by an appropriate health care professional. Once medically cleared by an appropriate health care provider and symptom free for a minimum of 24 hours, individuals may begin the protocol. Each step occurs with a minimum of 24 hours between.

  • Step 1:  15 Minutes of Light Aerobic Activity (walk, exercise bike, etc.). If no return of symptoms, then:
  • Step 2:  30 Minutes of Light to Moderate Aerobic Activity. If no return of symptoms, then:
  • Step 3:  30 Minutes of Moderate to Heavy Aerobic Activity. If no return of symptoms, then:
  • Step 4:  30 Minutes of Heavy Aerobic Activity and 15 Minutes of Resistance Exercise (Push-ups, Sit-ups, Weight Lifting). If no return of symptoms, then:
  • Step 5:  Return to Practice for NON-CONTACT Limited Participation. If no return of symptoms, then: 
  • Step 6:  Return to Full Practice WITH CONTACT. If no return of symptoms, then:
  • Step 7:  Return to Competition

If at any time the individual has a return of signs and/or symptoms they should immediately stop activity and be re-evaluated by the health care provider. When cleared to resume they should begin at the last step reached prior to the return of their symptoms.

How can I help prevent concussions?

We can reduce risks and limit the severity of concussions by using proper, well-maintained equipment, identifying and evaluating the injury promptly, and ensuring that the individual does not return to play too quickly after the injury.

Medical evaluation should involve an assessment of the individual’s signs and symptoms, balance testing, and a neurocognitive component. A CT or MRI scan of the brain may also be appropriate. Many organized sports also participate in baseline testing before the season as a tool to better evaluate and manage an individual’s safe return to play following a concussion.

The risk of head injuries at all levels can be reduced through participation in programs like Heads Up Hockey. The basic components of the program are:

  1. Know the basics of injury prevention.
  2. Practice on-ice or on-field safety exercises.
  3. Promote fair play on your team — and insist on the same from your opponents.
  4. Check equipment before, during, and after each practice session or game.
  5. Keep in good shape through flexibility and strengthening exercises.
  6. Know what to look for and how to respond when a player gets hurt.

In order to properly decrease the risk of concussions, organizations should educate athletes, coaches, and parents about the dangers and potential problems associated with head injuries, and insist that individuals practice safe techniques and wear the right protective equipment for their activity. This equipment should fit properly, be well maintained, and be worn correctly.

I urge coaches, parents, and athletic trainers to always err conservatively when managing concussions. You could save a life.

Sources: CDC; Sports Concussion Institute; Brain Injury Assoc. of America; AAOS; USA hockey. 

Lynne Young is a certified athletic trainer with OPA and serves on the Alaska School Activities Association’s Sports Medicine Advisory Committee.

*Alaska School Activities Association