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.

Posted by Grady Memorial Hospital on Oct 13 2011. You can follow any responses to this entry through the RSS Feed. Comments can be made below.