Concussion - What is it, What to Look For, and What to Do If You Have One
Compiled for SHINE by: Sarah K Rowe, LAT, ATC
What is a Concussion?
A concussion is an injury to the brain caused by a jolting force. You don’t necessarily have to hit your head to sustain a concussion, a whip lash affect can cause one. The sudden movement of this jolt causes the brain to bounce around in the skull, hitting the edges (think egg in and egg shell). This bouncing damages brain cells which in turn leads to changes in the chemicals in the brain and can also lead to a decrease in blood flow to the brain. These chemical changes can be dangerous and lead to a myriad of different symptoms. While some concussion and symptoms may appear mild they are all dangerous. Every concussion or suspected concussion needs to be
taken seriously and treated appropriately.
What to Look for If an Athlete is Suspected of Sustaining a Concussion
Some symptoms of a concussion an athlete will report. Some will be obvious to an observer or someone who knows the athlete. These include:
Feeling like they have pressure in their head
Nausea or Vomiting
Blurred or Double Vision
Balance Problems (either reported or observed, some athletes will have trouble walking in a straight line or may stagger as they walk)
Sensitivity to Light (sometimes athlete’s will describe everything seeming overly bright)
Sensitivity to Noise (noise makes symptoms worse or things can seem overly loud or pronounced)
Feeling slowed down
Feeling like they’re “in a fog”
Just “don’t feel right”
Trouble Remembering either things that happened before the injury or things that happened since the injury
Fatigue or Low Energy
Being more emotional than usual including sadness and irritability
Nervous or anxious
Sleep issues, either having trouble falling asleep, having trouble staying asleep or sleeping more than usual.
One thing you will often see when an athlete is suspected of having a concussion is an eye check. With this you are looking to see if the pupils are equal and reacting to light like they should and that they eyes are moving in a smooth motion. This is best assessed by a health care professional. While eye movement and pupillary reaction are an important sign to look for they are not the only thing that should be assessed. If an athlete appears dazed and is having issues answering questions or you have any doubt it is best to get them assessed. If an athlete shows any combination of these signs and symptoms they should be taken to see a health care professional, preferably one who has been trained in the evaluation and management of head injuries. If an athlete displays any of the following symptoms they should be rushed to the local emergency department immediately:
A seizure occurs
Loss of consciousness or progressive confusion
Difficulty with speech or use of arms or legs
Progressive nausea or vomiting
Any symptoms appear to be getting progressively worse, especially in the first 24-48 hours after injury.
All of the above are indicators of a much more serious brain injury. Again when in doubt it is always better to get an athlete assessed, you can replace a hip or knee down the road but you can’t replace a brain.
What Should be Done if a Concussion is Suspected
If an athlete is experiencing any of the above issues it is very important to remove them from the game or practice immediately. Once the athlete has been removed from play you need to seek medical advice. If you have access to a Certified Athletic Trainer they are a great starting point! Certified Athletic Trainers or ATCs are trained in the assessment and treatment of concussion and will be able to refer the athlete for follow up with an appropriate medical professional. It is important that whoever you seek treatment from has a background and training in the evaluation and management of concussions. Rest is a very important factor in recovering from a concussion, especially for the first 24-48 hours. Avoid a lot of phone use, loud music, TV or anything else that has a high level of stimulation. Like any other injury you want to let the injury part (in this case the brain) rest and recover and then slowly work it back to activity. It may be a good idea to stay home from school or take half days for the first day or so. Also avoiding test or large assignments since concussions often affect the cognitive function so grades may not be up where they should be.
Once the athlete is feeling better having them ease back into everyday life is important. Returning to academics as tolerated then once the athlete is symptom free returning them to athletic using a stepwise progression. You don’t want to throw an athlete back into full contact sports right away, starting them out with light jogging and increasing their activity to heavier aerobics, sport specific non-contact drills, light contact and then full contact is important. At each step you will want to make sure the athlete’s symptoms haven’t returned. Again if you have access to an ATC they are a great resource to help with this. Always you want to work with your health care professional to make sure everything is done safely and the athlete is truly ready to return to sports.
What if an Athlete Returns too Soon?
Returning an athlete to activity too soon can have devastating consequences. If the brain hasn’t had time to fully heal the chemicals will still be in a state of imbalance. If an athlete receives a second hit (even a small blow that may not cause injury to a fully healthy brain) while the brain is in this unbalanced state with decreased blood flow can cause the chemicals to become even more unbalanced and the blood flow decrease to a dangerously low level. This can cause a condition referred to as Second Impact Syndrome (SIC). SIC causes rapid swelling in the brain and has a mortality rate close to 50% and a morbidity rate of 100%, meaning that symptoms will last for a lifetime. This possibility of death and almost certainty of lasting symptoms whether from SIC or another condition caused by returning too soon is why it is so important to seek medical advice and not risk returning to activity too soon.
Information for this article is compiled from the CDC Head’s Up program: