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Featured Article - Concussions
Concussions: Clarifying the Confusion
There has been a big push recently by the media regarding concussions, management of concussions, and returning to play following a concussion on all levels of competition. While this is great information for the public to better understand and recognize concussions, it also creates an over saturation of information. With various media outlets reporting on concussions, the reliability of the information starts to come into play. A simple online search engine query of “concussions,” yields over four million results across all spectrums on the topic.
With such a vast array of information at your finger tips, it is easy to see how a person can become perplexed and overwhelmed. This article is meant to simplify the current medical knowledge on clinically diagnosing a concussion, management of a concussion, and return to play criteria. [Please note that only an allied health professional (doctor, nurse, certified athletic trainer, etc.) can clinically diagnose a concussion. For any injury where a concussion is suspected, contact your medial provider]
Much like a soccer player can sprain their ankle and injury the ligaments in the foot, a concussion is an injury to the brain. Trauma to the head can occur at any time and under any circumstance, simple or severe. With regards to soccer, head trauma can occur following a headed ball, colliding into an opponent, or falling directly onto the back of the head after jumping in the air. Extreme care should be taken when any head trauma is sustained. Immediate recognition of ABC’s (airway, breathing, & circulation) should be observed first and cervical/neck injuries should be assessed immediately and ruled out. If there is a cervical injury suspected and there is no allied health professional on hand to assess, contact EMS immediately (9-1-1) and DO NOT move the individual.
Once all other injuries are ruled out, and a concussion is suspected, immediately discontinue any physical activity (gym class, practice, game, etc.). The following symptoms should be expected following a head trauma:
- Headache
- Vertigo (dizziness) and/or poor balance
- Mental confusion and difficulty remembering events pre and/or post injury
- Lethargic (laziness) and a feeling of “out-of-it.”
The presence of the following symptoms indicates a severe head trauma, and requires immediate medical attention:
- Blurred vision
- Abnormal drowsiness
- Ringing in the ear
- Unequal dilated pupils
- Loss of appetite and/or nausea (vomiting)
- Slurred speech
- Weakness in arms/legs
- Tingling in arms/legs, hands, fingers, toes
- Bleeding from the ear
- Clear fluids flowing from ear
- Convulsions or shaking
Once an individual sustains a concussion, they are prohibited from any physical activity until cleared by a medical physician. If an individual sustains a second head trauma while still suffering from symptoms from the previous head trauma, further and permanent brain damage can be sustained called “second impact syndrome.” The damage sustained from a “second impact syndrome” can be permanent brain damage, coma, and even death. Great care should be taken with any individual who is still suffering from post-concussion symptoms. Tragically this was all too real when an elementary student from Muskego suffered a concussion at a youth football game. He was properly removed from the game and subsequent actives for awhile according to his parents. However, while he was playing on some equipment during gym class a few weeks following his concussion, he fell onto his head accidentally, slipped into a coma, and sadly passed away.
Proper care should be taken by all individuals who suffer a head trauma, and it is not uncommon for an individual to be removed from school due to symptoms. Unfortunately, there is no way to rush a recovery for a concussion, and is best to take a very conservative and cautionary approach. Excessive mental stimulation from video games, cell phones, and lights can increase the symptoms and should be closely monitored by the parents. It is not uncommon for individuals to be removed from school following a concussion due to the inability to process the material. Parental monitoring of the daily progress, both physically and mentally is highly recommended and can be crucial if the symptoms worsen.
Ultimately, the conservative treatment of concussions is the best treatment, especially in younger populations. The slogan for a majority of high school athletic associations is “When in Doubt, Sit ‘Em Out”. An extra week or day of non-physical activity may seem like an eternity for a child, but is the best decision in the end. An adolescent and youth brain is still growing and maturing, and by rushing back to activity following a head trauma will have dire effects down the road as they mature. For further information, please visit the following websites for more information regarding concussions:
WIAA: http://www.wiaawi.org/index.php?id=430
Wisconsin Sports Concussions: http://www.wisportsconcussion.org/
National Athletic Trainers Association: http://www.nata.org/sites/default/files/MgmtOfSportRelatedConcussion.pdf
You can also contact the Froedtert Sports Medicine Center via phone: (414) 805-7111; or email me directly: lsolum@froedterthealth.org regarding any further questions about concussions.
