Sport Concussions : The Good, The Bad and The Ugly
Unfortunately, concussions are an inherent risk of any sport. There are now estimated to be over 3 million concussions per year, most in adolescent and pediatric age groups. The top sports for concussions are football, soccer, lacrosse and basketball. There is no protective gear that will prevent a “mild Traumatic Brain Injury” which is medical lingo for concussion. The definition of a “mTBI” is when there is an “impulsive” force transmitted to the head that affects brain function in at least one of the following ways:
- Physical, e.g., headache
- Cognitive, e.g., feeling foggy
- Emotional, e.g., irritability
- Sleep, e.g., drowsiness
When I started out as a board-certified sports medicine Provider 20 years ago, if an athlete just had is “bell rung”, it was acceptable to return him/her to the game if symptoms cleared quickly. The good news is that medical experts have come to a consensus of how to better manage this situation so the athlete’s brain stays healthy. The athlete should not be allowed to return to game or practice that same day. What should be done?
The first is an objective “on the field” assessment such as SCAT2 ( Sports Concussion Assessment Tool 2). This includes evaluation of concussion symptoms, orientation, memory, concentration, balance and coordination. Once it is established that a concussion has occurred, then the athlete should be medically evaluated. If the athlete had loss of consciousness more than 30 seconds, severe headache, seizures, focal neurologic findings, repeated vomiting, slurred speech, prolonged disorientation, or significant irritability, a Cat Scan of head should be considered. The third step is the rehabilitation stage which includes:
- Complete rest of body and brain ( e.g., video games, TV, exercise, and possibly even school). This is the key treatment.
- Progressive exercise regimen. If any symptoms of concussion occur, must stop activity.
- Return to sport with continued monitoring of return of symptoms.
A lot has been written about neuropsychologic baseline testing such as ImPact. This test can be helpful in providing objective data but cannot replace clinical judgment by health care provider. These type of tests have not been validated with athletes at the grade school level.
As has been evidenced in the news as of late, the bad and the ugly of concussions can be prolonged or permanent loss of brain function all the way up to death, e.g., “second impact syndrome”. The good news is that when managed properly, the vast majority of athlete’s can safely return to the sport that they enjoy. With the intensive amount of research being done in this area, management will continue to refined and improved.
Joseph Sliwkowski MD
AFC Urgent Care, North Andover