Monday, November 11, 2019

Concussions in the Student-Athlete – What They Are and What to Do About Them



By Christopher Ng, MD
Pediatric Resident at The University of Texas at Austin Dell Medical School
Member, Texas Medical Association

We’ve all seen the play: a helmet-to-helmet tackle in football, an off-balanced rebound where a player hits the floor in basketball, or a slide tackle where the tackler gets clipped in the head in soccer  even cheerleaders falling on top of one another after a stunt goes wrong. The injured athlete gets up and goes to the sideline to be evaluated, and is diagnosed with a concussion. But what is a concussion? What are those docs on the sideline looking for? And for our teenage athletes – What can we do to prevent lasting brain damage that will affect you for the rest of your life? 

A concussion is a type of traumatic brain injury that’s caused by a force of impact to the head – or a hit to the body – causing the head and brain to move back and forth. The brain bounces around inside the skull, damaging it. Sometimes the injured person loses consciousness or is in an altered mental state. Concussions are relatively common in sports, accounting for almost 10% of all high school athletic injuries. The concussion count might be even higher considering how many people – especially student athletes – don’t report their symptoms.

When a player gets hit in the head, the sports doctors or athlete trainers on the sidelines typically will ask a series of questions and memory quizzes to assess the player’s cognitive condition (whether he or she is thinking clearly). They also will check for other things that suggest the injured player is incapable of going back into the game, including imbalance, slurring of speech, and poor coordination. If there’s any question of a concussion at all, the player will be pulled from the game until further evaluation. The doctor also will conduct a physical exam to ensure there are no fractures or other injuries that need immediate referral to an emergency department.

Concussion symptoms do not always develop immediately after the injury but typically present within hours to the first few days after the injury. Some examples are:

  • Headache,
  • Confusion and disorientation,
  • Memory problems or amnesia,
  • Blank staring or “stunned appearance,”
  • Problems with walking or dizziness,
  • Vomiting, and
  • Emotionality.

One Myth

Many people think a player must “pass out” or lose consciousness on the field to have a concussion, but most concussion sufferers actually never lose consciousness. However, most people who are “knocked out” do suffer a concussion. And sometimes a person can experience a concussion without visible structural damage on imaging tests like CT scans or MRIs. That’s why any head injury needs to be treated with a serious approach.

Next Steps

After someone suffers a concussion, the first thing to do is to schedule a follow-up appointment with either a sports-medicine specialist or the player's primary care doctor. There, the physician can assess the patient to see if any further symptoms are developing. He or she will assess the player over time until the doctor clears the player to undergo the school’s return-to-play protocol. It’s crucial that the injured athlete doesn’t reinjure his or her head. A player who gets hurt during this healing period risks suffering a condition called second impact syndrome, which could cause serious injury like brain swelling, brain herniation (pressure in the skull that moves brain tissues), or even death.

Athletes should return to practices and games only when they have demonstrated full recovery. Most schools’ return-to-play protocols set a step-by-step course to return to action. The timing to return to school and to competition is gradual and varies player to player. The average recovery period is two to three weeks. Most doctors recommend that players undergo brief physical rest for one or two days after the injury. Until recently, medical experts recommended that players rest for even longer. However, newer studies reveal that players who start noncontact, supervised, light aerobic activity (walking or riding a stationary bike) might have a quicker recovery. Therefore, new recommendations are being developed based on those findings – as long as the light exercise doesn’t severely exacerbate the athletes symptoms.

What About Schoolwork?

When it comes to activities requiring cognitive abilities like schoolwork or testing, players should get back to the books only if their symptoms allow it. Long amounts of screen time are discouraged, as that can worsen symptoms. Once players can concentrate up to 30-45 minutes at a time without their symptoms worsening, they can return to school. Recuperating players take an average of one to two days off from school post-injury. Once back at school, a recovering player might initially need adjustments – such as break times at the nurse’s office or reduced class time. This should be worked out among the student-athlete, his or her parents and medical team, and the school.

Medicine 

Some physicians may prescribe medications for lingering symptoms a player might have, such as headache, nausea, vomiting, or sleep issues, but these typically are needed only for a few days post-injury. If symptoms continue for more than three to four weeks, a player may want to ask his or her primary doctor about seeing a specialty team for care.

Long-Term Effects

In general, most athletes recover from a concussion without severe repercussions. However, a second head injury – or multiple concussions over the course of a sports career – can lead to more permanent damage. Chronic traumatic encephalopathy, a neurodegenerative disease caused by repeated blows to the head, is undergoing more study and discussion in mainstream media.
Having a concussion can be a scary and troublesome injury to overcome. However, with the right medical team in place, players can quickly recover and return to play without compromising their future.

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