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Concussion: ​When in doubt, hold them out

​​​​​​​​​​It is estimated more than 3 million concussions occur each year in the United States in recreational and organized sports. This is more than the reported figure of 300,000, which includes only concussions where the athlete suffered a loss of consciousness.

Concussion is a type of mild traumatic brain injury. Sports medicine clinicians have established these major features as comprising concussion:

  • It may be caused by a direct blow to the head, face, neck or elsewhere on the body with the force of the hit transmitted to the head.
  • It typically results in quick onset of short-term impaired brain function that will resolve on its own.
  • Loss of consciousness may or may not occur.
  • Standard diagnostic imaging, such as CT or MRI, does not show damage caused by concussion

Concussions comprise an estimated 9 percent of all high school sports injuries with girls suffering a higher rate of concussion than boys do in similar sports. The highest risk for concussion resides with football, followed by girls’ soccer. Other high-risk sports include rugby, ice hockey, lacrosse and basketball.

Indicators of a concussion include:

  • Physical Symptoms - headache, nausea, vomiting, problems with balance, sensitivity to light and noise
  • Cognitive Symptoms - feeling dazed, problems with concentration and memory, difficulty with answering questions or thinking trough information and processes
  • Emotional Signs - nervousness, irritability​, sadness

Some symptoms may occur at the time of the injury; others may occur shortly thereafter or even days, months or years later.

Treatment begins on the field with evaluation of the ABC’s (airway, breathing and circulation) and the potential for cervical spine injury. Athletic trainers who provide sporting event coverage have received training in providing recommended sideline assessments and will complete those after the field evaluation, as necessary.

If it is determined an athlete has suffered a concussion, the athlete should be removed from the remainder of the practice or game and not allowed to return that same day. The athlete should be monitored for several hours for deteriorating conditions. It may be necessary to have further evaluation in an emergency room. Neuro-imaging should be considered if injury to blood vessels is suspected. A referral for neuropsychological testing is more frequently used to evaluate brain function.

Concussion can be treated by allowing adequate time for full physical and cognitive recovery. The brain of a high school athlete is still developing, making cognitive rest key to recovery. Rest may include:

  • Staying home temporarily from school
  • Reducing the academic load or delaying test-taking
  • Refraining from exposure to text messaging, computer, television, video games or loud music
  • Prohibiting drive time because of impaired or slowed reaction time

Athletes should be held from physical exertion until they have no symptoms at rest. Hold off from:

  • Weight training
  • Cardiovascular conditioning
  • Gym classes​​

When in doubt, hold them out. There is no universal definition as to when an athlete is able to return to play after suffering a concussion. Rather, return to play should follow an individualized course until no symptoms are experienced at rest or with exertion.

Article submitted by Laurel Rudolph, M.D., Marshfield Clinic

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