Concussions in Young Athletes

What is a concussion?

Although there is no universally recognized definition of a concussion, it generally includes any traumatically induced alteration in mental status that may or may not involve loss of consciousness. Common symptoms include:

Confusion Headache Nausea Vomiting

Dizziness Unsteadiness Feeling "in a fog"

Who gets a concussion?

Participants in contact and collision sports are especially susceptible to concussions. It has been estimated that 300,000 sports-related concussions occur every year and that 63% of these injuries are suffered by high school football players. In fact, 20% of all high school football players are believed to receive a concussion annually.

Other sports that are associated with mild traumatic brain injuries are soccer, wrestling and boxing. Athletes who are not expecting a sudden impact suffer most concussions.

What are the different types of concussions?

There are three different grades of concussions for which doctors systematically evaluate. The symptoms for the three types are:

• Grade 1 (mild) No loss of consciousness. Complaints may include ringing, headache, dizziness and memory loss
• Grade 2 (moderate) Loss of consciousness for less than 5 minutes or post traumatic amnesia lasting more than 30 minutes
• Grade 3 (severe) Loss of consciousness for more than 5 minutes or post traumatic amnesia for more than 24 hours

How do you treat someone who gets a concussion?

Treatment of a concussion is based on the severity of the head injury suffered. The following describes the course of action generally followed after an athlete has been evaluated and the grade of concussion has been determined:

It is very important that an athlete who has suffered a concussion be examined frequently, even following return to play, and should not be left unattended until all symptoms have ceased and examinations are completely normal.

Concussions are serious injuries, and return to activity afterwards is an important consideration. Some physicians believe in the importance of neurological testing regardless of the severity of the concussion.

What is the prognosis for an athlete who has sustained a concussion?

Many athletes who suffer mild concussions will return to normal mental status and be able to return to play soon after injury, provided that all symptoms have ceased. However, a complication of concussions that often goes unrecognized is post-concussive syndrome (PCS). PCS can last between a week and six months following a mild head injury and is recognized by headaches (especially during physical activity), irritability, dizziness, impaired memory and concentration, sleep disturbance, and fatigue.

Treatment for PCS is usually rest and close follow up, although symptoms may persist for months. Athletes should not return to play until all symptoms, such as headaches, are resolved. Many believe that a third concussion should end an athlete’s season indefinitely to avoid serious injury to the brain.

How can head trauma be avoided?

Prevention of head injuries in contact sports is crucial because the brain cannot regenerate after injury. Coaches and athletes should maintain appropriate conditioning for participation in sports, especially focussing on the neck muscles, which when strengthened will increase the amount of force needed to cause a concussion.

In addition, appropriate protective gear, especially helmets, should be worn at all time during play. Helmets should be fitted for each individual athlete and should be discarded if worn out. Medical care can be optimized if those on and off the field are able to recognize and categorize concussions and are aware of the serious implications of such head traumas.