A concussion used to be referred to as a “ding to the head” or “having your bell rung” and wasn’t taken seriously. Today we know that a concussion is a type of Traumatic Brain Injury (TBI) that changes the way the brain normally works. Even a mild bump to the head can be serious.
What is a concussion?
A concussion is caused by a blow to the head or a jolt to the body such that the brain shakes within the skull. In sports the blow can be from a fall or from an athlete colliding with another object - such as another player, a goal post, or the ground. The impact doesn’t have to be directly to the skull; it can be to the upper body or part of the head, such as landing on one’s jaw.
What happens next is a chain of chemical changes within the brain. These changes occur over hours and even days, which explains why often immediately after the impact the player might not seem so bad. With any type of head injury, even mild, it’s essential that the athlete be removed from play and not returned that day. If a player receives another hit to the head before the brain has a chance to heal, the results can be very serious - even causing death. This is called Second Impact Syndrome.
Signs and Symptoms
Per the Centers for Disease Control and Prevention, the following are signs to watch for:
Noticed by Others
- Appears dazed or stunned
- Is confused about assignment or position
- Forgets an instruction
- Is unsure of game, score, or opponent
- Moves clumsily
- Answers questions slowly
- Loses consciousness (even briefly)
- Shows mood, behavior, or personality changes
- Can’t recall events prior to hit or fall
- Can’t recall events after hit or fall
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Reported by Athlete
- Headache or “pressure” in head
- Nausea or vomiting
- Balance problems or dizziness
- Double or blurry vision
- Sensitivity to light
- Sensitivity to noise
- Feeling sluggish, hazy, foggy, or groggy
- Concentration or memory problems
- Confusion
- Does not “feel right” or is “feeling down”
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What To Do If a Player Gets a Head Injury
Remove the athlete from play! Do not try to diagnose on the sidelines. Inform the player’s parents/guardian and seek a medical evaluation. The concussed player should not resume physical activity until cleared by a medical professional trained in head injury management.
Academics will also be difficult, since the brain is used in learning, reading, studying and test-taking. A gradual re-entry plan developed between the child’s school and medical professionals is essential to allow the brain’s healing process (see McGrath N. Supporting the Student-Athlete’s Return to the Classroom After a Sport-Related Concussion. Journal of Athletic Training. 2010;45(5):492-498).
Concussion Facts
- Each year, U.S. emergency departments treat an estimated 135,000 sports- and recreation-related TBIs, including concussions, among children ages 5 to 18. (MMWR July 2007)
- Athletes who have ever had a concussion are at increased risk for another concussion.
- Children and teens are more likely to get a concussion and take longer to recover than adults.
Myths vs. Reality
- You need to be knocked out for it to be a concussion. Most concussions do not result in a loss of consciousness, or blacking out.
- You cannot let a person with a concussion fall asleep. We now know that the absolute best thing for the injured brain is rest. Since your brain is used to process information from all your senses, “brain rest” means cutting back on every day activities such as watching TV, reading, video gaming, and using a cell phone.
- My child needs a brain scan to diagnose a concussion. The brain changes from a concussion cannot be picked-up by a scan. Your doctor will determine if your child’s symptoms indicate the need for a brain scan, such as an MRI or CT, to determine the extent of the injury.
- An expensive helmet will prevent a concussion. While a good quality helmet can help lessen the chances of a skull fracture, a helmet will do nothing to prevent the shaking of the brain inside the skull during a concussion. In fact, some players feel overly confident with an expensive helmet and use the head against another player. The head should never be used as a weapon and many sports are banning head-to-head hits.
- If I report my concussion, I’ll never be able to play contact sports again. It’s essential that a concussion be reported to your coach, family, and doctors. Steps will be taken to allow your brain to heal. Depending on the severity, most athletes recover fully from a concussion and can resume playing.
Helpful Resources:
Centers for Disease Control and Prevention - http://www.cdc.gov/concussion/sports/
Sports Concussions.org - http://sportsconcussions.org/
Sports Legacy Institute - http://www.sportslegacy.org/
Brain Injury Association of America - http://www.biausa.org
Author: Linda Connor Lacke, MPH (2011)
Injury Prevention & Outreach Coordinator
Mass. General Hospital - Trauma Division