Every parent of a student athlete dreams of that big moment—the winning touchdown, the crucial goal, the concussion.
Naturally, concussions aren’t part of the dream, but they’re a major factor in the reality of athletics today. Concussions, we now know, aren’t just simple knocks on the noggin. The old “shake it off” attitude has yielded to a more enlightened outlook because the consequences of untreated concussions are serious and lasting.
Still, many aspects of concussions are misunderstood. What should you know? Consider these tips.
Symptoms tell the story
What is a concussion? It’s not totally understood, but it’s known that anything causing the brain to knock violently in the skull causes “an alteration in the biochemical activity,” says Dr. Christopher D. Kager, Lancaster NeuroScience & Spine Associates (www.lancasterneuroscience.com).
CAT scans can reveal serious physical consequences from a hit to the head, such as a brain bleed, but they won’t find concussions. In fact, a 2014 study reported in Pediatrics found that emergency room doctors could do more to discover and treat concussions for patients who come in with head injuries.
ER doctors are well-trained in brain injury and brain hemorrhage, but more “probably need to get concussion training,” says Dr. Paul S. Lin, OSS Health, York (www.ossortho.com).
Concussion diagnosis is “symptom-driven,” says Kager. Most patients will have a headache, and perhaps nausea, vomiting, amnesia and problems with vision. There may also be “a slew of secondary things… depression, anxiety, restlessness.”
The Centers for Disease Control and Prevention (www.cdc.gov/concussion/sports) offers online resources, including free online training, that teach parents and coaches to spot the signs.
Prevention works, to a point
Teams are increasingly attentive to proper techniques meant to prevent the kind of forceful hits that force the head to move rapidly, says Kager. Among sports, football is a major violator, but other sports have their dangers, such as soccer, lacrosse and cheerleading (yes, cheerleading, when the flyer isn’t caught or kicks a squad-mate in the head on the way down).
Proper equipment, such as a soccer headband, can help, but “it’s never going to reduce all of the risk because it’s not necessarily the impact of your head into something,” says Kager. “It’s the impact of the brain inside the head.”
Rest is best
Medications are unlikely to help, say physicians. Complete rest at first, followed by a phase-in to all activities, is the best prescription.
Rest means avoiding not only physical activity but cognitive exertion as well. Students diagnosed with concussions should stay out of school and avoid tests. Why does resting from thinking help? Scientists aren’t sure of the exact cause, but they know that concussion is “a metabolic disturbance,” says Lin.
“I like to think of it as an energy crisis. It takes a lot more energy to do things that may have been taken for granted. The more you tax the brain, the more likely you make the symptoms worse and make the recovery longer than we’d like it to be.”
Lin might allow minimal activity during recovery, such as light stretching to help the patient stay in shape for the return to sports, but “any sort of taxing physical activity very likely will exacerbate symptoms and make it last much longer.”
In recovery, moderation is key. The return to classwork is phased in. So is the return to sports. Kager often stages the return over a week, going from light aerobic exercise to a moderate jog or run, then to some sport-specific drills or full-contact practice, and, finally, to full play. The critical piece is the absence of symptoms for 24 hours before moving to the next phase, he says. If the symptoms return, “then it’s back to square one.”
Lin also encourages patients to avoid texting, watching television and using computers, although a few minutes a day can be allowed as a calming device, because anxiety is another taxing activity that can slow recovery.
“It’s hard to comply,” Lin admits. “You kind of have to scare patients a little bit into the reality of injuring their chances of competing at a higher level.”
Multiple concussions mean more consequences
“The majority of concussions that are sports-related generally resolve spontaneously within seven to 10 days, but 20 percent of patients have prolonged symptoms,” says Kager. “In a teenager or younger, we worry about the fact that their brain is still developing. We worry that it could lead to a more significant likelihood of long-term injury.”
Another hit before a concussion patient is fully recovered can cause “second-impact syndrome,” risking “prolonged neurological deficits and protracted recovery,” Lin says. Studies show that multiple concussions can impair memory and learning.
Some studies also show that one concussion doubles the risk of another concussion, and a second concussion doubles the risks again. “Why that is, we don’t know,” says Kager. “It might have to do with reaction time, or they might be prone to concussion.”
That’s why recovery time has become an imperative. “We don’t want people suffering concussion on top of concussion before they’ve fully recovered,” says Kager.
