Sports Safety – Concussion

Part of keeping kids safe while they play sports is the prevention and treatment of injuries. Today we will discuss concussion, including symptoms, prevention measures, activities most at-risk for concussion, treatment, and return-to-play protocols.

What is a concussion?

A concussion is an injury involving the brain that temporarily disrupts normal functioning. Concussion usually occurs from a blow or sudden jolt to the head, but it can also be caused from impact to the body that causes a whiplash effect of the head. 

Symptoms of a concussion are varied and may depend on the severity of the injury.  They can be noticeable right away or develop slowly over time. Symptoms of concussion may include any number of the following: 

• Dizziness
• Loss of balance
• Confusion or feeling “mentally foggy”
• Loss of consciousness
• Trouble with memory and/or concentration
• Amnesia about the event
• Nausea and/or vomiting
• Headaches
• Vision changes – blurry or seeing double
• Light sensitivity
• Noise sensitivity
• Slow mental processing – answers questions slowly
• Mood changes – irritable, depressed, overly emotional
• Sleep disturbances – more or less sleep than usual

Why do we worry about concussion?

Any injury that involves the brain is concerning. The brain itself is soft and spongy, and is surrounded by fluid for protection from contact with the hard bones of the skull. Concussion injury occurs when outside forces cause the brain to move too rapidly for the fluid to protect, and it strikes against the skull. This causes damage to nerve cells and blood vessels and stimulates chemical changes that interfere with normal brain functioning. The more significant the injury to the brain, the more severe the symptoms usually are and the longer it takes for recovery. Debilitating symptoms of concussion can last for days, weeks, or even longer. Repeat concussion injuries that are close together are often worse, because the delicate tissue of the brain has not yet fully recovered before it has been injured again. 

We do not know how many concussions are “too many” before permanent damage to the brain occurs, but repeated concussions are of higher concern for long-term effects to the brain.

Are some activities more prone to concussion?

While it is true that people most often think of concussions occurring in “collision sports” such as football, soccer, and rugby, it is important to keep in mind that accidents or injuries in any activity can result in concussion. They occur from falling off of bicycles or skateboards, falling from playground equipment, falls during cheerleading and gymnastics, falls during horseback riding, and car or ATV accidents.  

That being said, some sport activities do carry a higher incidence and risk of concussion and head injury than others. 

Sports with higher rates of concussion in boys:

• Ice Hockey
• Rugby
• American Football
• Lacross

Sports with higher rates of concussion in girls:

• Ice Hockey
• Soccer
• Lacross
• Cheerleading

If your child’s sport is on this list, it does not mean that he or she needs to stop playing! My own children both play soccer and love it, and I would only make them stop playing if they were to actually have issues with concussions. If your child’s sport is on this list I only ask you to be aware of the risks, teach your young player to be safe, to listen to the coaches, and play by the rules which are there to keep them playing safely. 

How do we treat concussion?

The best treatment for concussion is rest, both physical and mental. The severity of the concussion will determine the severity and duration of the rest. School activities will need to be modified, including decreased classwork and testing and excused participation from gym class. Video games and extended screen time should be avoided. Pain relief medication, primarily NSAIDs (non-steroidal anti-inflammatory drugs) such as ibuprofen, may be needed for headache and neck pain. 

When can a child return to play?

Recovery time from a concussion is variable. Light physical activity, such as walking, may be recommended but return to full play of a sport will be a gradual progress as the athlete improves. No athlete should return to play before fully recovered, and should be cleared by the doctor before returning. Engaging in full-contact play before fully recovered can lead to worsening of symptoms and put the athlete at a higher risk for a more severe secondary concussion if they are receive another head injury. 

As the athlete returns to play and normal school activities, any worsening of symptoms should be reported to the doctor immediately. Many schools have athletic trainers in the sports programs that can assist with the gradual return to play process. 

How can we prevent concussion?

Obviously, it is not possible to prevent every concussion. Even if high-collision sports were no longer played, concussions would still happen through falls and accidents. There is evidence that rates of concussion are decreasing, likely due to increased awareness and prevention, but they do still occur more frequently than we would like to see. However, it is possible to avoid or reduce the risk of severe concussions. These prevention measures include:

• Helmets. Properly fitted helmets should be worn consistently with bicycles, ATVs, dirt bikes, skateboards, snowboards, hover boards, horseback riding, and etc. Helmets are also required in certain sports, such as football, lacrosse, and ice hockey. 
• Sports technique. All athletes should be taught proper playing techniques, and to follow all of the rules of their particular sport. Whether it is “heading” a soccer ball or tackling a football opponent, following the proper technique and rules of the game is important. 
• Early recognition. It is very important for players to notify coaches or parents if a head injury has occurred, so that the player may be evaluated quickly and thoroughly and receive proper medical attention if needed. 

Never ignore a head injury, no matter how minor. The American Academy of Pediatrics recommends: “When in doubt, sit them out!”

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