Written by Mark Halstead, M.D., FAAP
With fall upon us, and football season in full swing, concussions in young athletes are once again a hot topic. Despite all the attention paid to concussions in football, athletes in other fall sports, such as soccer, volleyball and cheerleading, also are at risk for a concussion. More than 25 states now have laws to educate and protect players by requiring them to read materials on the signs and symptoms of concussions and mandating that they not return to play for a minimum of 24 hours after their concussion. These laws also require athletes to receive medical clearance from a health care professional before they can return to play.
Concussion Signs and Symptoms
The most common symptom that athletes report after a concussion is a headache. Some will have their headache right away, but others may take several hours or longer to develop. Another important thing to remember is that not every single player will get a headache after their concussion, so it is important to know the other signs and symptoms.
Other common signs and symptoms include dizziness, sensitivity to bright light and sounds, feeling “foggy,” difficulty remembering things that happened before and/or after the injury, feeling sick to their stomach, being very tired, and confusion. A common myth in concussion diagnosis is that a player needed to be knocked out, or lose consciousness, to have a concussion. In fact, less than ten percent of athletes with a concussion will be knocked out.
It is important that athletes, coaches and parents be aware of these signs and symptoms, as there may not be an obvious outward sign of a concussion. It is also imperative that athletes are honest about their symptoms and report them immediately.
What to Do If You Suspect a Concussion
If an athlete is suspected to have a concussion, they should be immediately removed from the game or practice. They should not be allowed to return to activity the day of their injury. Any athlete who has a severe headache, is repeatedly vomiting, is difficult to arouse, has seizure activity, or has difficulty moving their arms or legs may have a more severe head injury and should be evaluated in the emergency department.
Following a concussion, if symptoms persist, the athlete should refrain from any physical activity that increases his/her heart rate. Exertion often aggravates symptoms, especially in the early days following the injury. The athlete should follow the advice of the health care professionals managing the injury to determine when it is the right time to return to physical activity.
A newer concept in dealing with concussions is called “cognitive rest.” This means that an athlete may need to reduce their mental activity to avoid increasing symptoms. Some examples of cognitive rest may include a shortened school day, reducing workloads in class, decreasing reading, spending less time in front of a computer or allowing for extra time to complete tests or assignments. Not every athlete will need all forms of cognitive rest, but athletes should avoid things that worsen their symptoms.
For athletes that are of driving age, another consideration is to have that athlete avoid driving until symptoms of the concussion are resolved. Reaction time is often delayed following a concussion, so an athlete may be at higher risk for an accident if she/he drives.
When an Athlete Can Return to Play
In order for an athlete to return to play, he/she must be free of symptoms of the concussion both at rest and with exertion. A return-to-activity progression is frequently used and increases the level of exertion and exposure to contact situations over a five-day period. Athletes may fill out a symptom checklist or take a computer test to assess their recovery. Most importantly, the athlete should receive clearance from a health care professional before returning to play. Ideally that health care professional is someone knowledgeable in the diagnosis and management of a concussion.
One concern about returning too soon from a concussion is developing second impact syndrome. This condition may develop if an athlete suffers a second head injury before the initial injury has healed. This may lead to a severe brain injury and even death.
With improved efforts in education, new laws being passed and better protective gear, hopefully we will see improved outcomes from youth sport concussions. Teammates can help by letting coaches know if someone doesn’t seem right following a head injury. Coaches can help by not pressuring players to return before the athlete is ready and by encouraging their players to disclose symptoms. Finally, athletes can help themselves by being honest about and disclosing their symptoms and not returning to play before being cleared to do so.
View the full fall 2011 issue of the ACSM Fit Society® Page supported by Liberty Mutual online.