Blow to the head is more than just a ‘ding’
With the fall sports season in full swing, concussions top our list of injury concerns due to their frequency and danger. Unlike other sports injuries, concussions are invisible, potententially misleading the athlete into a false sense of well being since there are no physical wounds or abrasions to warn of such injury. Without proper diagnosis and management, concussions can lead to long-term complications and even death.
A concussion occurs when a jolt to the head compresses soft brain tissue against the hard bone of the skull, resulting in bruising, swelling or tearing of tissue.
Any athlete involved in a contact sport is at risk for a concussion. However, the risk is higher in some sports than others. For instance, the frequency of concussions of all game injuries is 8.5 percent in women’s lacrosse (without head gear), 6.5 percent in women’s soccer, 4.5 percent in football, 7.5 percent in ice hockey, and 2.7 percent in baseball.
To put it another way, in football, our most popular sport this fall, the risk of concussion per 1,000 athletic exposures (incidents of contact) is 1.8 percent. The Centers for Disease Control estimates that 3.8 percent of college, high school and elementary school students will sustain a sports-related brain injury this year.
We used to cavalierly dismiss a blow to the head as a “ding,” but heightened awareness, rule changes and treatment advances have increased our ability to protect student athletes even as they have grown bigger and faster and the collisions have become more violent.
Many people equate a concussion with loss of consciousness, but a player does not have to be knocked out to have a concussion. It is just one of multiple symptoms, any one of which can determine a diagnosis. Signs of a concussion include headache, confusion, memory impairment, distractibility, disorientation, emotional instability, nausea or vomiting, dizziness, loss of balance, loss of appetite, slurred speech, blurred vision, extreme drowsiness and loss of consciousness.
In most cases, we can diagnose a concussion on the sidelines. But sometimes the symptoms may not materialize until hours or even days after the injury. That’s why we encourage parents to be vigilant and call a physician as soon as they recognize any of the aforementioned signs. In their desire to tough it out and maintain their competitive edge, student athletes are not always open about their symptoms.
Once a concussion is diagnosed, the first step is to remove the player from the activity and keep the player inactive until clearance is received from a physician, preferably a sports medicine or concussion specialist. Most people fully recover with rest and adherence to a concussion protocol.
Athletes experiencing a loss of consciousness should be immediately seen by a physician and may need additional care at the Emergency Department to evaluate for a possible neck injury.
To avoid a more serious injury, we want to make sure the athlete is completely healed before returning to play. The physicians at Grady Memorial Hospital and throughout the OhioHealth system use a computerized neurocognitive screening tool called ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing) to evaluate post-injury condition and track recovery for safe return.
Once the symptoms are gone, we follow a very specific five-day protocol that exposes the patient to a series of tests to see if the symptoms return under progressive levels of exertion.
Prevention focuses on behavior and education about concussions. It is especially important that athletes wear properly fitted safety gear.
Most athletes recover from a concussion, but any injury to the brain is serious and requires prompt medical attention and appropriate treatment.
Kenneth O. Cayce IV, MD, is a board certified family and sports medicine physician specializing in sports medicine at MAX Sports Medicine. He is team physician for Olentangy High School and Denison University. Max Sports Medicine now has an office at the Delaware Health Center.