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Sports Concussions

Sports Concussions

According to the U.S. Centers for Disease Control and Prevention, about 200,000 people in the United States suffer concussions while playing sports every year. Concussions occur in a wide range of sports and affect all athletes, from professional players to little leagues.

Concussions are mild traumatic brain injuries, and sports concussion has become a significant problem. It has recently made headlines with reports about the consequences of returning to play too soon, as well as research findings into the long-term effects of the injury.

Recognising concussion and providing proper treatment is especially important for younger athletes because it typically takes them longer than adults to fully recover.

Despite many attempts by experts, there is no clear definition of concussion. It is uncertain whether any damage to the brain occurs from a concussion. Imaging tests, such as computed tomography (CT) scans and magnetic resonance imaging (MRI) scans, typically do not detect any brain damage — such as bruising or bleeding — in concussion patients.

A concussion does, however, temporarily impair how the brain functions and processes information. For example, after a concussion, a patient may have difficulty with balance and coordination, memory, and speech.

A concussion is typically short-lived. Most people recover within 7 to 10 days. Unfortunately, once an athlete has sustained a concussion, he or she is at greater risk for additional concussions. Repeat concussions can have long-term consequences, so prevention is essential.

Symptoms

The most common symptoms of concussion include:

  • Drowsiness

  • Headache

  • Loss of consciousness

  • Memory loss

  • Irritability

  • Confusion

  • Balance problems, dizziness

  • Difficulty speaking and communicating

  • Depression

  • Nausea and vomiting

  • Changes in sleep patterns

Imaging Tests

Magnetic resonance imaging (MRI) and computed tomography (CT) scans provide doctors with detailed images of the skull and brain. As stated above, results from MRI scan and CT scans are most often normal in concussion patients, so these tests are not usually helpful in diagnosing the injury.

If the neurological examination indicates problems, such as trouble with your vision, your doctor will order imaging scans. Also, if your symptoms worsen over time, CT and MRI scans are important for guiding treatment.

Neuropsychological Assessment

Neuropsychological testing helps to measure the effects of concussion on mental capabilities. This kind of assessment can be done using computerized tests, or during a session with a neuropsychologist.

The testing provides valuable information on a range of mental functions, such as short-term and long-term memory, attention and concentration, problem-solving, and speech.

Balance Assessment

Many athletes are unsteady on their feet for several days following a concussion. Balance testing is a way for doctors to assess how well the part of the brain that controls movement is functioning.

There are several balance tests your doctor might use, as well as more sophisticated force plate technology. Force plates are instruments that measure the forces of stepping, running, jumping and other actions. They are typically rectangle-shaped and may be used in a stand-alone device, or inserted in machines that resemble exercise equipment, like treadmills or stair steppers.

Treatment

The key to healing from a concussion is complete rest. This includes not just physical rest, but mental rest, as well. Reading, computer work, video games — even television — should be limited until all symptoms have resolved. This typically takes 7 to 10 days, although some people have symptoms for weeks or months after the injury.

Once you are free of symptoms, you can gradually return to physical and mental activity. It is important to slowly return to daily activities because being symptom-free does not mean the brain injury has fully healed. Your doctor may recommend a step-by-step program: first add an activity, then monitor your symptoms. If your symptoms do not return, you can continue increasing the challenges.

This slow, steady approach typically reduces the time spent away from school, work, and athletics because it provides enough time for the injury to heal. Diving back into activities as soon as your symptoms have resolved can bring them back on and require a return to complete rest.

New Recommendations

In 2010, the American Academy of Pediatrics recommended that young athletes with concussions be evaluated and cleared by a doctor before returning to sports. The American Academy of Neurology issued a similar statement, and stressed that doctors who clear athletes for return to sports should be trained in managing and assessing sports concussions.

Baseline Evaluations

Because it is difficult to determine when a concussion has fully healed, baseline neurocognitive evaluation is an important tool for assessing whether it is safe for an athlete to return to play. Before the sports season starts, each athlete takes a computerized test that measures brain functions, such as memory and reaction time. If an athlete later has a concussion, post-injury tests can be compared to the baseline evaluation to measure the severity of the concussion and help doctors monitor healing.

In addition, pre-season evaluations can help identify athletes who have had previous, unrecognized concussions and who are at risk for repeat concussions. For example, past injuries to the face or neck may have been accompanied by an unrecognized concussion.

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