With summer sports starting, comes the return of sports injuries, including head injuries and concussions.  As parents, it is important to understand the signs and symptoms of a concussion as well as their long-term effects.

 

What is a concussion?

A concussion is a type or traumatic brain injury, or TBI, which is caused by an impact of the body with enough force to causes the head and brain to go back and forth.  This rapid movement can cause the brain to bounce around or twist, which can result in damage to brain cells inside the skull.

What are the signs of a concussion?

The signs of a concussion can be immediate or can take hours or even days to present.

Signs that can be observed include:

• Can’t recall events prior to or after a hit or fall.
• Appears dazed or stunned.
• Forgets an instruction, is confused about an assignment or position, or is unsure of the game, score, or opponent.
• Moves clumsily.
• Answers questions slowly.
• Loses consciousness (even briefly).
• Shows mood, behavior, or personality changes.As symptoms progress, the individual may report some of the following:

• Headache or “pressure” in head.
• Nausea or vomiting.
• Balance problems or dizziness, or double or blurry vision.
• Bothered by light or noise.
• Feeling sluggish, hazy, foggy, or groggy.
• Confusion, or concentration or memory problems.
• Just not “feeling right,” or “feeling down”.

There are several “danger” signs that need to be recognized and if present, these require immediate evaluation at the nearest emergency room. These include:

• One pupil larger than the other.
• Drowsiness or inability to wake up.
• A headache that gets worse and does not go away.
• Slurred speech, weakness, numbness, or decreased coordination.
• Repeated vomiting or nausea, convulsions or seizures (shaking or twitching).
• Unusual behavior, increased confusion, restlessness, or agitation.
• Loss of consciousness (passed out/knocked out). Even a brief loss of consciousness should be taken seriously.

What is the recovery time from a concussion?

All head injuries should be evaluated by medical personnel.  Currently, there is a minimal time of 5 days before returning to any activities. Although most concussions take only a few days to resolve, some symptoms from a concussion can linger for weeks to months.  Rest is the most important factor in recovering from a head injury.  While resting, it is important to minimize any stimulation to the brain.  Physical activity or any activity that may require concentration, such as doing homework, watching TV, or playing video games, may cause the symptoms of a concussion to return and worsen.  In addition, any activities that cause the head or brain to be jostled, should also be avoided (playing sports, riding a bicycle, riding roller coasters).  Returning to activities too soon can put an individual at risk for greater injury.  If the athlete suffers another concussion before completely recovering from initial head injury, there is an increased incidence of prolonged recovery or even severe brain swelling (second impact syndrome) with devastating or even fatal consequences.

Returning to Sports

The athlete should only be allowed to return to sports once cleared by their health care provider. The Center for Disease Control (CDC) has recently adopted the HEADS UP policy regarding concussion management. These steps should take a few days to be completed.  An athlete should only move to the next step if they do not have any new symptoms at the current step. If an athlete’s symptoms come back or if he or she report new symptoms, this is a sign that the athlete is pushing too hard. The athlete should stop these activities and the athlete’s medical provider should be contacted. After more rest and no concussion symptoms, the athlete can start at the previous step.

HEADS UP STEPS:

Baseline: Back to School First
Athlete is back to their regular school activities, is no longer experiencing symptoms from the injury when doing normal activities, and has the green-light from their health care provider to begin the return to play process.

Step 1: Light aerobic activity
Begin with light aerobic exercise only to increase an athlete’s heart rate. This means about 5 to 10 minutes on an exercise bike, walking, or light jogging. No weight lifting at this point.

Step 2: Moderate activity
Continue with activities to increase an athlete’s heart rate with body or head movement. This includes moderate jogging, brief running, moderate-intensity stationary biking, and moderate-intensity weightlifting (less time and/or less weight from their typical routine).

Step 3: Heavy, non-contact activity 
Add heavy non-contact physical activity, such as sprinting/running, high-intensity stationary biking, regular weightlifting routine, non-contact sport-specific drills (in 3 planes of movement).

Step 4: Practice & full contact 
Young athlete may return to practice and full contact (if appropriate for the sport) in controlled practice.

Step 5: Competition
Young athlete may return to competition.

In summary, even though most concussions are mild, all concussions are potentially serious and can result in prolonged brain damage or even death if not recognized and managed properly.  Remember, you cannot see a concussion and most sports concussions occur without loss of consciousness.  If there is a suspected concussion or your child reports signs or symptoms of a concussion, seek medical attention as soon as possible.  All Illinois schools are now required to follow the IHSA policy which requires written clearance from a physician licensed to practice medicine or certified athletic trainer, working in conjunction with a physician.

Adapted from the CDC and the 3^rd International Conference on Concussion in Sport, in conjunction with the Illinois High School Association