Concussions in Sports FAQ

By Michael Yorio, MD

In Sports, What is a Concussion?

A concussion is a type of traumatic brain injury caused by contact to the neck or head.  There are several different grades or severity of concussions.  They can occur from a simple bump or jolt to the head.   Sometimes, they can occur with contact to the body that causes the head or brain to move rapidly back and forth.
The impact creates a change in the brain leading to the symptoms associated with a concussion.  We define a concussion as a traumatic brain injury where the symptoms may last from a few minutes to several weeks.  It really will all depend on the grade of the concussion.

How Do You Get a Concussion?

• Direct impact to the head or neck
-Some sports are “higher risk” for impact injuries.
• Some styles of play are “higher risk”. (improper tackling)
-Improper equipment or equipment does not fit correctly.
• Improper instruction on the safest way to tackle.

 

High School Sports 2010
Concussions per 100,000 Athletic Exposures

 

Can we reduce risk of head injuries?  

We can certainly do many things to reduce the risk of head injuries.  At all levels of sports, many changes have caused a decrease in the number of concussions and severity.  Improvement to sports equipment, education of athletes and coaches, early recognition of signs and symptoms and other changes to the rules of the sport have significantly helped reduce the risk.

However, in contact sports there will always be a risk for this injury.   You cannot completely ensure that a concussion cannot occur.

 

Proper Coaching

It is important that all levels of coaches are teaching the safest or correct way to participate in the sport.

• Proper technique (tackling, headers)
• Stay on your feet
• Control aggressive play or reckless.
• Head gear: helpful or harmful?

How can you keep your child safe?

• Create a culture of safety
• Bike helmets, playgrounds with soft material, etc.
• Tell them to report head injuries and or symptoms of concussions
• Ensure they follow safety rules and use of equipment properly
• Encourage good sportsmanship and avoiding hits to the head

Is It A Concussion?

The first step to determine a concussion is to observe:
• Look for signs of a possible traumatic brain injury

 

• Lying motionless for a period of time → Possible loss of consciousness?
– Grabbing Head
• Unsteady Gait (wobbly upon standing)
• Evidence of facial trauma
-Remove From Play
• Talk to Them
• How do you feel?
– Oriented to current situation
• Do they seem like themselves?

What symptoms might a person with a concussion have?

• Headache or pressure in the head
• Dizziness or Balance problems
-Nausea or Vomiting
• Sensitive to light or noise
• Confusion
– Feeling “out of it” or “in a fog”
• Memory Loss
• Blurred vision

How can you spot a possible concussion when you didn’t see the hit?

• Reports concussion symptoms
• Unable to recall events prior to or after a hit or fall
– Appears dazed or stunned
• Zoning out during play, confused with plays or position assignments
• Moves clumsily
– Answers questions slowly
• Behavior or personality changes

When do you start to see concussion signs and symptoms?

• Immediately
– Can be delayed (minutes, hours, next day)
• Check for signs right after the injury and reassess periodically

What should you do if you suspect a concussion?

• Remove the athlete from play
• When in doubt, sit them out!
– We don’t say “mild” or “bell rung”, so if symptoms are present assume injury until an evaluation by a Health Care Provider
• Seek medical attention from someone trained to diagnose and manage concussions

When to go to Emergency Room/Call 911

• One pupil larger than the other, double vision
• Drowsiness or inability to wake up
– A headache that gets worse or does not go away
• Slurred speech, weakness, numbness, decreased coordination
• Repeated vomiting, convulsions, seizures, numbness
– Loss of consciousness

Recovery from a Concussion

• Rest
-Take it Slow
• Talk to your health care provider

Recovery Keys

• Limit physical activities
• Cognitive Rest
– Avoid mental activities that trigger symptoms
• Electronics with screens, cell phone, loud music
• Crowded, noisy rooms
-Return slowly to cognitive activities (If it causes symptoms, stop doing it)
• Recovery time is different for each individual and each injury

When Can I Return to Play After a Concussion?

For the State of Florida:
• For High School Athletes, Form AT 18 must be in their file if diagnosed with a concussion:
– Standardized Return to Play Protocol for High School Athletes
• Prior to Starting the Return to Play Protocol, the athlete must meet 5 criteria:

1. Symptom resolution
2. Normal neurological examination
3. Off of all pain medication
4. Returned to school without academic restrictions
5. Neuropsychological test scores post injury have returned to baseline (if applicable)

What About the Computer Test?

• Computerized Neuropsychological Testing
• Easily administered in schools and medical clinics
– Assesses memory and reaction speeds
• Take a baseline before the season and compare to post injury
• Best when post injury test is performed after athlete is symptom free
– It is a tool to assist in the management of concussions
• It is not helpful in the diagnosis of a concussion

Return to Play Protocol

There should be a gradual, progressive increase in aerobic exercise, strength training, balance and skill activities, and cognitive stress
The athlete should be monitored by a health care provider familiar with the signs/symptoms of a concussion.  They should only be allowed to normal activities after the approval by the appropriate healthcare provider.

•Stepwise process to return to play, each step usually 1 day:

-Light Exercise
• Walking, swimming, exercise bike
-Less than 70% maximum HR
• No weight lifting

 Sport Specific Activity

1. Non-contact drills, can add weight lifting
3. Non-contact Practice
4. Full Contact Practice
5. Release to Competition by appropriate healthcare provider

What can happen if you return to play too soon?

There is a greater chance of getting another concussion and for a more serious injury.  A repeat concussion that occurs while the brain is still healing from the first injury can lead to a more severe concussion and symptoms.  There is also a risk that the damage to the brain can be fatal. It’s better to miss a game or two than an entire season!

Summary

Create a safe environment to participate in sports and allow a safe return to the sport.
• Observe, Remove, and Talk to Them
Remember Red Flags that may mean more than a concussion
• Seek the assistance of an appropriate health care provider
Rest and recovery, Return to School, Return to Play

Dr. Yorio at JOI is the MD who manages the JOI Concussion Program. Dr. Yorio is located at the San Marco location.  Call JOI-2000 to schedule an appointment.

JOI and JOI Rehab

JOI Physicians continue to offer online new patient appointments. This is another option to make it more convenient to make new patient appointments with less phone hold times. Follow the link below to select your JOI MD and schedule online.

You can still call 904-JOI-2000 to make new patient JOI Physician Appointments if that is your preference.

To make appointments with JOI Rehab, please call 904-858-7045.

By: Dr. Michael Yorio