What exactly is a concussion?
A concussion is the mildest form of brain injury that can occur. Interestingly, this can occur from a trauma to the head, or can occur if the body is rapidly accelerated or decelerated. In other words, hitting your head is only one way you can get a concussion. You can also be concussed by being stopped in your tracks while running such as in a football tackle. Even if your head never was contacted by the other player or the ground, you can still have a concussion. This happens because your brain is floating in an enclosed container, your skull. Since it is floating, it can shift around within the skull anytime the skull changes directions rapidly. If the shifting is severe enough, a concussion results.
How can you protect yourself from obtaining a concussion? Does a good helmet make a difference?
Yes and no. A good helmet can prevent you from obtaining a more severe head injury, but it cannot protect you from having a concussion. For example, you are less likely to have a skull fracture if wearing a helmet, and less likely to have a facial fracture if wearing a helmet with a face guard. However, remember the brain is floating within the skull. If the skull accelerates or decelerates rapidly, the brain shifts within the skull causing a concussion (or worse). The helmet does not change this shifting. Neither do soccer headbands. A good analogy is having an egg in a glass bottle wrapped with bubble wrap. If you drop the bottle, the egg will still crack and spill, but the bottle may not break since it was protected by bubble wrap. So, our brain may “crack” like the egg, but the skull protected by a helmet may not fracture, just like the glass protected by bubble wrap may not break after a fall. Of course, you should still wear a helmet to prevent the potentially more serious injuries. However, a concussion will still occur if you run fast enough and get stopped abruptly by a fall, a tackle or having a ball hit your head even when wearing protective gear like a helmet.
When should I be evaluated for possible concussion?
Concussions are frequently hard to determine by the athlete themselves. Common symptoms of concussion include headache, nausea, fatigue, sensitivity to light and sound, and confusion. However, each person with a concussion may have one or more of these different symptoms…so is it really “just a headache” or is it a concussion? Sometimes it can be hard to tell.
It is important to have a healthcare professional determine the severity of the injury. If your coach, athletic trainer, fellow athlete or you think you might have a concussion, you should stop your sport and be evaluated by a medical professional who can help you with this determination. It is recommended to see a physician for concussion evaluation.
Why is it so important to stop your sport when you suspect you may have a concussion? How do you determine when it is safe to return to sport?
Yes, concussions are the mildest form of brain injury, however, they still can result in serious consequences if not treated properly. You could have permanent brain damage or even die from a head injury. However, if you are diagnosed properly by a medical professional, treated appropriately given your individual circumstances and returned to sport appropriately, you will experience a mild injury — one that recovers completely.
Although standards have continued to evolve, the current internationally agreed upon plan to return to sport involves the following:
• Complete resolution of all patient symptoms. So, will you tell the truth to your doctor that your headache is really gone? Or will you be thinking it is a migraine, or fatigue headache and blow it off? Honesty here is important.
• No physical exam findings concerning of neurological problems. Ideally this should include a doctor’s evaluation as well as computerized vision testing for coordinated eye movement, and computerized balance testing. The best way to determine the importance of these findings is to have these tests done before the sports season so you know what is normal for the athlete, then use the tests again after the injury to ensure they area back to normal. Without those physical exam baseline tests, it is hard to tell with accuracy when an athlete is “back to normal.” But the testing can still be utilized after a head injury and the data is helpful, just not as helpful if baseline data is not available.
• Completely normal cognitive functioning. Are you really “thinking normally”? Computerized testing that checks for reaction time, short-term memory, distracted concentration, and persistent concentration is a very valuable tool, and is most valuable if a baseline test is performed before the injury occurs.
You also need someone who is qualified to interpret the test and make recommendations based on the findings. For example, if your reaction time is slow, you shouldn’t be driving or riding a bike. If your continuous concentration is low, you shouldn’t be working or performing in a school setting in the normal way.
• Demonstrated ability to progress from light sports activity to real-time sports activity over a five-day period without regressing in recovery. Yes, even after you feel fine, and your doctor thinks you are fine, you still need to demonstrate you are fine in your sport.
Ascension Medical Group Seton Sports Medicine
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