Sports-related concussion: Brush up on the latest safe practices
Safe practices when it comes to sports-related concussion is an area of medicine that is always being re-evaluated. Following the Fifth International Consensus Conference on Concussion in Sport, a new concussion consensus statement was released by some of the world’s experts on the subject. While much has remained the same, there are some new ideas.
Recognize and remove
As a coach or parent, it is extremely important to know what a concussion is and is not. Concussion is caused by a blow to the head, neck/face or other area of the body in which forces are transmitted to the head. It causes symptoms that may develop immediately or within 24-48 hours after the injury. It represents a functional injury to the brain, meaning the brain does not function quite as well as an uninjured brain. Brain functions that are affected include balance/equilibrium, sleep, mood, cognitive function (e.g. short term memory).
The most common initial symptom of a concussion is headache, but dizziness, confusion or disorientation are also common. You do not have to lose consciousness to get a concussion. If an athlete sustains a blow to the head or body and seems not quite right, the adage is, “when in doubt, hold them out.” No athlete should be returned to play if a concussion is suspected on the same day.
It is important to have a licensed medical professional evaluate any athlete with an injury before return to participation can be authorized. In our state, physicians, nurse practioners, physician assistants and athletic trainers are the providers who can help with this process. Certified athletic trainers are very useful for sideline evaluation of head injuries. They understand and are skilled at return to play progression once concussive symptoms resolve.
It is important to remember that sports-related concussion is a functional, not structural, injury to the brain, so standard brain imaging is often not helpful as it shows us brain structure. There are emerging imaging modalities that may be able to help give more information about concussions, but they are primarily used in research at this point.
Rest is the cornerstone of concussion treatment, but this does not mean you need to stay in a dark room with no stimulation until symptoms are resolved. Current medical evidence does not support this beyond 24-48 hours after the injury. It is important to gradually reintroduce normal daily activities as part of the recovery process. It is like rehabilitation for your brain. I like to start the process of return to school as soon as is reasonable. Also, a good night sleep is often one of the best treatments for concussion recovery (8-10 hours without interruption)!
Most individuals recover from a concussion within 10-14 days, but this can vary widely. Younger children (under 12 or 13) often take longer to recover.
In cases where recovery is longer than four weeks, there are some risk factors that are often involved: poor sleep, high levels of initial symptoms, previous history of concussion, pre-injury headaches, pre-injury mental health struggles and even ADHD. These risk factors must be evaluated and treated as needed to help facilitate recovery.
Recognizing and removing injured players helps prevent longer and more difficult recoveries from concussion. The new consensus statement suggests that in soccer, officials should be calling red cards for elbowing in heading duels, as this is one of the highest risks for head injury in the game. There has not been strong evidence to support the use of head gear in preventing sports-related concussions.
New considerations from the consensus statement
Two of the other new considerations of the updated consensus statement include:
- Focus on return to learning/school and sports for schools, with consideration to educating school staff
- Discussion of gradual return to aerobic activities (walking, cycling or running) before complete symptom resolution can actually be helpful in shortening recovery times, especially for those experiencing longer lasting symptoms (with guidance of an expert)
If your student athlete has experienced a head injury during practice or play, it’s critical to get them examined by a trained medical professional, even if concussion has been tentatively diagnosed on the field. MultiCare Orthopedics & Sports Medicine providers are experts at diagnosing and treating concussion.
About The Author
Joshua Purses, DO, is a MultiCare orthopedics and sports medicine specialist who treats both children and adults. He has offices in Tacoma, Gig Harbor and Olympia.