Although we hear the word "concussion" fairly often, most of us are unfamiliar with what concussion syndrome actually looks like in real life. What are the symptoms of a concussion? And what should you do about it if you suspect a concussion? The answers to these questions are essential for anyone involved in sports. Whether you are a coach, an athlete, or the parent of an athlete, you need to be able to recognize the signs of concussion syndrome.
The Centers for Disease Control and Prevention reports that nearly 1.6 to 3 million people encounter sports-related concussion syndrome every year. Nearly 329,290 school athletes in sports departments all over the country were treated for concussion syndrome.
On average, one concussion syndrome case occurs in every American football game. With the increase in wages, the interest and participation in contact sports, like football, ice hockey, and rugby have been on the rise.
What Is Concussion Syndrome?
Concussion syndrome describes the neurological deficit or brain injury that occurs when the head is impacted. It also occurs when the brain is forced to come to a sudden halt. The brain sits suspended in the skull in cerebrospinal fluid. When you force the brain to stop violently, and abruptly, the brain hits the skull at peak velocity. This causes the brain tissue to suffer an injury or bleed.
A good example of concussion syndrome is Will Smith in the movie, Concussion. By itself, it isn’t life threatening unless there’s a bleed that can turn lethal. But it does present with long and short-term problems. One of the long-term issues associated with repeated episodes of concussion syndrome is CTE (Chronic traumatic encephalopathy), which has been in the news a lot.
Concussion syndrome can be mild or severe. In mild concussion syndrome, the person may not lose consciousness. Or if he or she does, then it's for a brief period. Athletes often feel drowsy or dazed after a blow to the head. On the other hand, severe concussion syndrome is where the person loses consciousness for an extended period. Here, there is a significant delay in returning to normal.
Signs and Symptoms of Concussion Syndrome
It’s very important to recognize the signs and symptoms of concussion syndrome. Parents, coaches, teachers, referees, umpires, support staff, teammates, and athletes themselves should be able to identify them. The responsibility of recognizing concussion syndrome shouldn’t fall on the medical staff alone. Train everyone to know it when they see it.
Athletes who’ve experienced concussion syndrome often complain of headaches, fullness, or pressure in the head, nausea, vomiting, and blurry vision. Additionally, they experience loss of coordination of their limbs, ringing in the ears, lack of balance, sensitivity to light and noise.
Many reported it was difficult to concentrate and they had memory problems. They felt confused, which is they would ask the same question again and again. Consequently, they’d experience, dizziness and anxiety over trivial issues. Some would find themselves irritable and unable to sleep.
Other signs that medical staff looks for in people with concussion syndrome include appearing stunned and "out of this world." They answer questions very slowly and can’t understand simple instructions. They may forget what they’re doing there or can’t recall events before the knock.
Also, they move clumsily or get aggressive or appear withdrawn. Some displayed obvious behavior and personality changes. Others demonstrated visible withdrawal from their normal pattern.
If You Suspect Concussion Syndrome
Even if there’s a hint of concussion syndrome in an athlete, have them removed from play. Get a healthcare professional or a trained member of your medical staff to evaluate them. If an athlete has had a knock, pull him off the field and examine him. Telling him or her to “shake it off” is plain wrong and is dangerous.
If the person has loss of consciousness, more than one episode of vomiting, slurred speech, drowsiness that won’t go away after thirty minutes, or a change in movements or behavior then take them to the emergency room right away. Take precautions for neck injuries as well, if a person needs to vomit roll them over.
A question that usually arises is about sleep. Should we allow them to sleep? Yes, but it's necessary to wake them up at thirty-minute intervals just to make sure that something more serious like a traumatic brain injury hasn’t taken place. Don’t give them an aspirin until the medical team rules out any brain bleed.
Diagnosis of Concussion Syndrome
The doctor will get a history of the injury first. This helps him or her to decide whether to run blood tests, X-Rays, or a CT scan depending on the nature of the injury. So be prepared to explain the injury, the time the person was knocked unconscious, the number of episodes the person vomited, and other signs and symptoms. It will give the doctor an idea of the severity of the injury.
Consequently, you should have a file on the past medical history of the athlete. This must include a list of all the medications they take, the allergies they have, other neurological injuries of the past such as seizure disorders, spinal injuries, etc. If there’s a history of bleeding or clotting disorders, make sure to tell the doctor.
Doctors will then perform a physical exam which will always involve a neurological exam. They will inspect the ears and mouth for a cerebrospinal leak, and check for spinal injuries.
However, the best diagnosis will come from radiological imaging to rule out any other serious injury. This includes getting an X-Ray to check for a skull fracture and a CT. The CT is the best way to check for brain tissue damage and bleeding. It doesn’t take too long to get these images, and the doctors can report on them within an hour.
Treat Concussion Syndrome
Treatment of concussion syndrome involves bed rest and fluids. Basically, it involves symptomatic management. If there are bruises, you can use ice covered with a cloth to ice these bruises every thirty minutes.
In mild concussion cases, doctors will expect the person to heal and perform self-care at home, with a follow-up evaluation in 24 to 48 hours. Pain relievers such as Tylenol can help relieve pain and ease external swelling. Brain edema or brain swelling will require bed rest as the brain needs time to heal.
Ideally, concussion syndrome only takes 10 days to 2 weeks to heal. At most, younger athletes recover in a month. Younger people recover faster. But older people might take longer to recover, and the long-term effects could last weeks, months, or even years. Therefore, it’s important to keep all appointments with a neurologist for follow-up.
The use of protective headgear has been debated when it comes to prevention of concussion syndrome. While these are specifically to prevent external injuries and lacerations, they do minimize high-risk impact, though the evidence hasn’t been very encouraging. Rugby players wearing protective headgear did report less severe concussions, but since this was a self-reported study, the bias couldn’t be removed.
Along with this, neck strengthening exercises, encouraging a less reckless style of play, teaching better tackling techniques, limiting concussive blows, and prohibiting spearing will go a long way in preventing injuries that are associated with concussion syndrome.
Concussion Syndrome Prognosis
Single isolated concussion syndrome incidents have a very good prognosis. Athletes make a full recovery in these cases with few long-term side effects.
Post-concussion syndrome is real. Here, people who do have the initial concussion syndrome tend to keep having headaches longer than two weeks and sometimes even months after the incident.
Post-concussion syndrome is more common with a severe injury, but these people have symptoms of cognitive and behavioral change. Some of this may be very subtle. Their concussion symptoms will last months to a year. This does resolve on its own, but there’s no specific time-frame for its resolution.
The long-term effects are cumulative. With every concussion, the prognosis is going be worse every time. Repeated concussions will impact your brain. This can lead to dementia, psychiatric disorders, memory loss, and other neurological deficits.
There’s also SIS (Second Impact Syndrome) to consider. This is where athletes who suffer a concussion develop cerebral edema when they sustain a second injury, which leads to brain herniation and death.
When Is It Safe to Return to Play
Various individual programs and sports departments have created their own return to play programs and protocols. However, evidence shows that the all clear to return to sports especially contact sports need to have an evaluation by a medical physician. Concussion management protocol, when implemented by physicians, achieved safer concussion management.
Overall, the consensus is that if athletes have minor contusions or lacerations, they can return to play when the injury is healed. Some universities advise that athletes who have headaches and associated symptoms can play once their symptoms are fully resolved, and the neuro-cognitive tests are similar to the baseline.
If an athlete loses consciousness for less than a minute or experiences loss of memory for less than 30 minutes, they need to stay away from contact sports for a minimum of 10 days. And they must get an okay from a neurologist.
An athlete with loss of consciousness for more than a minute or memory loss for over 30 minutes but less than 24 hours would need 30 days to recover. The recovery time progressively increases with each injury.
A second-time injury would warrant 90 days away from the play. And a third-time injury would mandate 180 days from play. After three such successive injuries, players should refrain from contact sports completely.
A severe concussive period with memory loss for over 24 hours and loss of consciousness for over 5 minutes will require 6 months of recovery. It will also require an MRI before return to play to confirm there’s no residual brain damage. While you may feel like you can return to normal, always check with a medical professional first.
Where to Get Help?
Families have to make a lot of adjustments for those athletes with severe concussion syndrome. There are plenty of organizations that provide advice, resources and help for those who have to deal with this.
Family and social stressors delay healing, so a strong support system is essential to the athlete's recovery. If there are complications from the concussion and the brain tissue is damaged then look for caregiver assistance. Financial help is also available to those who require it.
In some cases, athletes will require rehabilitation. This is especially true if the injury was very severe. Part of the treatment can and will involve multidisciplinary teams of specialist and medical staff. These include physiatrists. They are doctors who specialize in rehabilitation medicine. They usually supervise the recovery teams.
Then there are neurologists who perform neurological exams and evaluate cognitive and brain functions. They are usually the initial members who are aware of your injury right from the beginning.
Therapists of various kinds, occupational, physical therapists, speech therapists are part of the team as well. These people are responsible for helping athletes return to their baseline functions with their thinking, language, and physical skills. Psychologists are also on board when memory, cognition, and behavior are affected.
The therapy and the team will change as the needs of the athlete change with time. There’s no one size fits all approach here. Because of the dynamic nature of the brain, combinations of various therapies are needed for different injuries. Most will heal on their own but its only the severe ones that will require such intensive care.
When in Doubt, Sit It Out
When it comes to concussion syndrome, prevention is better than cure. Educating teams, athletes, and staff about this are important. With all the attention focused on athlete death as a result of SIS, doctors and teams have become more vigilant about the growing number of deaths from secondary concussive episodes.
The American Academy of Neurologists has also updated its protocol and guidelines on concussion. Their motto is “When in doubt, sit it out!” They insist, remove players with a suspected concussion from play, no questions asked.
The National Football League Players Association, the American Football Coaches Association, the Child Neurology Society, the National Association of Emergency Medical Service Physicians, the National Academy of Neuropsychology, the National Association of School Psychologists, the National Athletic Trainers Association, and the Neurocritical Care Society have all endorsed these guidelines.