October 18, 2018
Members Of Female High School Soccer Playing Match

Spotting and Treating Concussions

by Amanda Z. Naprawa  

With the school year in full swing, so are sports—and they’re not your grandmother’s youth sports. From football to basketball to cheerleading, many children and teenagers are playing harder, more frequently, and more competitively than their counterparts in previous generations (consider the rise of the youth “travel team,” for example). With harder play comes a heightened risk of injuries, including concussions, which account for for close to 10 percent of all of sport-related injuries in high school athletes.But what exactly is a concussion? Could you recognize one if you saw it? And what should you do if you suspect someone you care for has one? Here’s a closer look at this common but often-misunderstood head injury.

What is a concussion?

The term concussionactually encompasses a variety of brain injuries in which the brain is shaken inside the skull. As a result of the brain bouncing around inside the skull, the cells in the brain stretch and are damaged, leading to an alteration in the normal chemical and electrical functioning of the brain.

Why concussions are becoming more prevalent is a matter of some debate. To some extent, the growth in reported concussions may be due to increased awareness of them, not just among health care providers but also among athletes, coaches, and trainers. There are also simply more kids playing sports today, often at highly competitive levels. With more young athletes and more exposure to competitive play, there are more opportunities for concussions, especially within certain sports. According to a 2014 report, sports with the highest rates of concussion among boys are football, lacrosse, wrestling, and soccer; among girls, soccer, lacrosse, and basketballhave the highest concussion rates. (The report was issued by the Committee on Sports-Related Concussions in Youth, a group convened by the Institute of Medicine and National Research Council to review the scientific evidence on concussions in young people from elementary through college age.)

What are the symptoms of concussion?

Common symptomsinclude headache, dizziness, confusion, blurred vision, nausea, vomiting, memory loss, poor coordination, emotional moodiness, fatigue, and light and noise sensitivity. But no two concussions are alike, and one person’ssymptomsmay be very different than someone else’s.This variability in symptoms might be one reason experts suspect that concussions are underreported. Differences in culture between communities and regions of the country may also play a role. For example, contrary to some conventional wisdom, a player can have a concussion without losing consciousness. But doctors in communities with deep sports traditions may hesitate to diagnose a concussion—and thus sideline a player indefinitely—if he or she wasn’t knocked out.

How are concussions treated?

Resting the body and brain for a short time after the injury can often improve the severity of symptoms and shorten the course of the post-concussion symptoms.Some patients are helped by limiting screen time (TV, computer, and video games). Students who are seriously affected should miss a small amount of school, particularly if symptoms interfere with effective learning. Educators can assist injured athletes with the return to school by following certain recommended accommodations, such as avoiding computer work and limiting test-taking or other activities that require prolonged periods of concentration.

When is it safe to return to sports practice and competition?

Until symptoms have resolved, athletes should put their training activities on hold, and certainly refrain from any activities where head impact is a risk.One of the reasons for avoiding contact sports until the concussion is healed is to avoid a rare complication known as Second Impact Syndrome (SIS). SIS occurs when the brain—not yet fully healed from the initial concussion—suffers a second injury and reacts with swelling andherniation. In severe cases, SIS can cause death within minutes. It may be of significantly greater concern for young children who often suffer more brain swelling than adults in head trauma.

While contact sports are off-limits until the concussion is totally healed, there is growing evidence that non-contact aerobic activity is safe for people whose symptoms are mild and steadily improving—and that it may actually aid in recovery, in part by easing the emotional stress that can occur when a person is isolated from their usual activities after a concussion.

As for getting back on the field (or ice, or mat), the sports-medicine community has a generally agreed-upon set of steps, known as the “return-to-play progression,” that an athlete must pass through in order to safely resume playing their sport. The steps begin with light aerobic activity and progress gradually to moderate activity, heavy activity without contact, practice with full contact, and finally competitive play. You can read more about the stages on the CDC website.

Are schools or youth teams doing anything to lower the risk of concussions?

Some youth, high school, and college-level football leagues have attempted to lower concussion rates by limiting the amount of contact during a typical week of practice.Football helmet technologyhas made the sport safer over the last half century by helping to prevent catastrophic brain injuries such as brain bleeding and fractures. Still, there is no such thing as a concussion-proof helmet. And in theory at least, today’s “improved” helmets could backfire by leading players to feel like they’re protected no matter what, and thus put themselves in more risky circumstances.

Bottom line: Concussions can be scary, and it can take time to recover fully. Following the recommended guidelines for rest and rehabilitation is an important step to getting your child back in the game as safely as possible.