A concussion is defined as a traumatic brain injury, where the brain experiences a jarring movement and the brain responds by swelling. The severities can vary from mild to severe and are based on many different factors including but not limited to the individual themselves, the mechanism of action, the protective equipment the athlete was wearing and more.
There are many preventative measures that can be taken such as rule changes and equipment advancements, but sometimes concussions are not preventable. In these cases it was pertinent to identify the traumatic brain injury early and take all necessary measures to ensure proper healing. Proper healing means completely letting the brain relax and only focus on living. This means that an athlete who has been diagnosed with a concussion should be removed from sport and school until the symptoms resolve. Stimulants like music, reading, lights, television, cell phones and video games should be eliminated during the healing process.
Some common misconceptions about concussions are that the athlete must lose consciousness in order to sustain a concussion. This has been shown over the years to be false, in fact most concussions now occur without a loss of consciousness. Another misconception is the athlete denying concussion and just saying, “I just got my ‘Bell Rung’.” This is also a fallacy; “bell ringers” are consistent with concussion symptoms. The athlete must not only feel better to return to play, but they must have close to baseline cognitive function, balance and normal neurological functions.
When an athlete demonstrates concussion like symptoms after sustaining a blow to the head or a whiplash type mechanism, the situation should not be taken lightly. If not recognized and treated appropriately, the athlete may never return to play. Second Impact Syndrome is a situation where the athlete returns to play before the brain has healed. If the athlete sustains another hit during this time diffuse cerebral swelling, brain herniation, and death can occur. For further information on Second Impact Syndrome, please click to watch Preston Plevretes’experience.
Harmon KG, Drezner JA, Gammons M, et al. American Medical Society for Sports Medicine position statement: concussion in sport. Br J Sports Med 2013;47:15-26.
The Korey Stringer Institute recommends the following guidelines:
- Schools should develop an EAP for handling potentially life-threatening injuries and a referral plan for concussions.
- Use certified helmets/equipment.
- The PPE (preparticipation exam) should include concussion specific questions.
- Preseason education for personnel, coaches, and athletes (should be tailored to the group being taught, strongly recommend educational materials for parents) on basics of concussion (i.e. that helmets do not prevent cerebral concussions, signs/symptoms, treatment, testing options, RTP).
- High school athletes suspected of sustaining a concussion are not permitted to return to a practice, game, or activity involving exertional activity on the same day.
- Athletes suspected of a concussion are not permitted to return to participation until written release from a licensed physician or athletic trainer.
- No child/adolescent should return to sport/activity unless he/she has managed to return to school.
- Implementation of a graduated return to participation protocol (see Zurich/AMSSM example, at least 5 steps, no more than 2 in one day).
- Comprehensive medical-management plans for acute care of a potential head or cervical spine injury.