Concussion in sports

Joseph M. Harris

A concussion is a mild traumatic brain injury that occurs when mechanical forces are applied to the head causing damage to brain tissue either on the same side or opposite side of the impact. It is the most common form of brain injury in sports and can occur with an elbow to the head, during a collision with another athlete, when an athlete is hit in the head by a ball, during a fall, or during a tackle.

Concussions can be hard to identify at times. Once an athlete sustains a concussion, they are four times more likely to sustain additional concussions. An estimated 300,000 sports and recreation traumatic brain injuries occur each year with an additional 750,000 to 2.2 million sport-related concussions going unidentified each year. The highest rates occur in sports where fewer participants are seen, such as football, while the highest number of concussion are reported in sports with higher numbers of participants, such as baseball. Football is the most common sport for traumatic brain injury in high school athletes.

Concussions are not always accompanied by loss of consciousness. Other early signs may include headache, dizziness, and lack of awareness of surroundings, memory loss, nausea, or vomiting.

There are a number of ways to grade concussions based on symptoms. Typically in a Grade 1 concussion, there is no loss of consciousness and no amnesia. The athlete may be briefly dazed and unsteady, and symptoms typically resolve within seconds or minutes. A trained professional should evaluate any athlete with a concussion, and the decision to return to play should not be made in haste. The decision to return to play should be individualized and based on the severity of the injury, the athlete’s history of brain injury, the time between injuries, the duration and intensity of symptoms, and the severity of the blow causing the concussion.

If an athlete is suspected of having a concussion, it is important he or she not be allowed to return to play until asymptomatic for 15 minutes if it is the first and a mild concussion or for one or more weeks for more severe concussions. This includes no symptoms at rest or during exertion. Some symptoms may occur later after a concussion. These may occur days or weeks after the injury and include trouble with memory, headaches, light-headedness, poor concentration, sensitivity to light or noise, fatigue, anxiety, and sleep disturbances. A rare but serious condition called second impact syndrome could occur if the athlete is allowed to return to play too soon. This is rapid swelling of the brain, which often results in severe brain damage or death.

If the athlete has confusion, worsening headaches, seizures, difficulty with vision, vomiting, neck stiffness or fever, weakness or numbness in any part of the body, urinary or bowel incontinence, or cannot be awakened, immediate medical attention should be sought. Multiple concussions may have cumulative and long lasting affects. Prevention of concussions includes rules to protect the athlete along with enforcement of these rules by officials. Also proper headgear and mouth guards help to prevent concussions. Teaching athletes proper techniques will also reduce risk of concussion.

It is important to understand that the symptoms of sports concussion are difficult to identify, and proper management is very important to protect the athlete from further injury.

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