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SPORTS RELATED CONCUSSIONS
Athletes involved in contact sports risk concussion every time they compete or practice. Too often the medical and public perception is that a concussion is a minor injury and need not restrict an athlete. In fact, sports many consider mild--such as soccer, gymnastics, or wrestling--still carry the risk of concussion. The risk of serious head injury is far greater, however, in other activities--such as football, hockey, rugby, boxing, and martial arts competition.
TYPES OF CONCUSSION
A mild concussion is one in which the person remains conscious but experiences temporary confusion, headache, dizziness, and short-term memory loss. Moderate concussion leads to amnesia, nausea, ringing in the ears, and momentary loss of consciousness (less than 5 minutes). A severe concussion results in loss of consciousness for more than 5 minutes as well as the above-mentioned symptoms.
Some head injuries are more severe than concussion, such as intracranial blood clots. Although these injuries result in major morbidity and mortality and may have to be treated with surgery, concussions may be bad enough to produce similar outcomes.
According to the American Journal of Public Health, of the 1.5 million high school football players in the U.S., 250,000 suffer concussions in any given season. In football, concussions most often occur when the player is making a tackle (43%), being tackled (23%), blocking (20%), or being blocked (10%). Concussion can lead to brain atrophy and psychological deficits. It is very important to note that the effects of concussion are cumulative.
SECOND IMPACT SYNDROME
A duplicate injury after a recent concussion can lead to a further devastating head injury with major swelling and occasionally death. The second impact syndrome, due to loss of autoregulation of blood flow and vascular engorgement, leads to massive increased intracranial pressure. This is most common in children.
POST CONCUSSIVE SYNDROME
The effects of head trauma may not manifest immediately but can lead to post-concussive syndrome. The symptoms consist of headache, dizziness, loss of balance, nausea, vomiting, visual changes, blackouts, forgetfulness, a decrease of attention and reaction time, and personality changes. The symptoms may be vague and may continue for days, weeks, months, or longer, with the symptoms being most pronounced in younger individuals. The symptoms are not dependent upon the severity of the injury and can increase over time if the initial problems are not addressed. By recognizing these symptoms in our patients, we can prevent the injuries and the symptoms of those injuries from becoming worse.
RETURN TO PLAY AFTER HEAD INJURIES
Injured players must be treated in a timely manner and evaluated as to when they may safely return to play--as a general rule, 10-20 minutes after mild concussions, several weeks after moderate concussions, and 60 days after a severe concussion if all symptoms have cleared (in consultation with their physician)
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