Concussions can be complicated injuries that can lead to life-long impairment if not treated properly. The healing process can be frustrating to athletes, parents and coaches, especially if there is a lack of knowledge about concussions and the necessary steps to recovery. Athletes have a greater chance for a safe, healthy, full return to sports when they adhere to a complete medical treatment protocol. This includes a medically supervised gradual/stepwise return to play program. The following information is intended to provide the athlete, parents and coaches with information on what to expect in the treatment of concussions.
What is a concussion?
- Concussion may be caused by a direct blow to the head, face, neck or elsewhere on the body from an impulsive force transmitted to the head.
- Concussion typically results in the rapid onset of short-lived impairment of neurological function that resolves spontaneously.
- Concussion may result in neuropathological changes but the acute clinical symptoms largely reflect a functional disturbance rather than structural injury.
- Concussion results in a graded set of clinical syndromes that may or may not involve loss of consciousness (LOC). Resolution of the clinical and cognitive symptoms typically follows a sequential course.
- Concussion is typically associated with grossly normal results on conventional neuroimaging studies.
What are the most common signs and symptoms of concussion?
An athlete can display a wide range of symptoms consistent with alteration of mental status. The athlete often will not know that the symptoms represent a concussion.
Unaware of period, opposition, score of game
Loss of consciousness
Unaware of time, date, place
Unsteadiness/Loss of Balance
Feeling “dazed” or “dinged”
Ringing in ears
The range and potential vague nature often make the diagnosis difficult.
How is a concussion treated?
- Athletes should immediately report any hit/trauma to the head or significant trauma to the body that results in ANY of the above symptoms.
- Any athlete with loss of consciousness, neck pain or deteriorating symptoms should be immediately evaluated by Emergency Medical Services.
- The athletic trainer or coach will complete an initial injury report to document the injury.
- The athlete should be removed from play and arrangements should be made for evaluation by a qualified physician.
- Time frame is dependent on the severity of the concussion and signs/symptoms.
- A time of “NO PHYSICAL ACTIVITY”= no activity that will elevate heart rate and blood pressure. This would include, but not limited to, all sports (organized, recreational, “pick-up/backyard”), weight lifting or moving of heavy objects, running, bike riding, skiing/snowboarding, and conditioning.
- BRAIN REST is key during this stage. This means no video games or excessive computer use. Adequate sleep and proper nutrition and hydration are also very important.
- Attending school full time is important, in the context of, adequate breaks during the day and assignment modification as needed.
- This may be a frustrating time for athletes and parents. Despite “feeling fine” athletes must adhere to the NO ACTIVITY period to ensure a complete recovery and reduce chances of long term effects.
- Daily honest reporting of signs/symptoms by the athlete is imperative.
After proper evaluation by a medical provider, the following should be considered…
- Avoid taking any medication unless directed by physician.
- Avoid alcohol, illicit drugs, or other substances that interfere with cognitive function and neurological recovery.
- Rest, but resume normal activities of daily living as tolerated, while avoiding activities that potentially increase symptoms.
- Eat a light, well-balanced diet that is nutritious in both quality and quantity. Hydrate adequately.
- Awaken athlete during the night to check for deteriorating signs and symptoms only if he/she experienced loss of consciousness, had prolonged symptoms of amnesia, or was still experiencing significant symptoms at bedtime.
When can athletes return to their sport or activity?
Once asymptomatic and cleared by the treating physician, the athlete will be guided by the athletic trainer through a gradual/step-wise return to play protocol. This often takes several days depending on the severity of the concussion.
A minimum of 3-7 days. The athletic trainer or coach will provide a specific daily program. Each step should generally take a minimum of 24 hours, as it is widely recognized that symptoms may not worsen at the time of exertion, but rather later in the day or even the next day. If any symptoms occur, the athlete should cease activity, drop back to the previous asymptomatic level the next day. If symptoms reoccur the athlete should return to resting until asymptomatic.
The slow return may be frustrating as well. However, it provides the necessary feedback on the condition/status of the concussion.
A return to full activity without restrictions is not only dependent on the physical findings of the physician and athletic trainer, but the HONEST reporting of signs/symptoms by the athlete.
CONCUSSIONS ARE SERIOUS INJURIES NOT TO BE TAKEN LIGHTLY. YOUR ATHLETE COULD SUFFER LIFE-LONG HEALTH ISSUES AND EVEN DEATH IF NOT TREATED PROPERLY.
Please feel free to call our office or your school’s certified athletic trainer with any questions regarding your child’s head injury!