The Truth About Concussion (continued)

It is obvious in today's athletic arena that concussion has become a priority for medical providers and sports organizations offering the most up-to-date information for prevention, diagnosis and treatment. The NFL hires spotters for games, impartial to a particular team, to watch for athletes that may have had a concussion and can call down to the field to have the athlete checked by medical staff.

Pop Warner football instituted a limited number of tackles permitted during practices. Many high schools apply ImPACT (TM) to test their athletes before the season starts. The culture of sports is changing from "what to do if there is a concussion" to "how do we prevent our athletes from having a concussion."

As a sports friendly doctor, I certainly want to see athletes continue to achieve success in their sport, and realize there is risk with almost every sport - from gymnastics to football. Without changing the sport itself, I can't imagine completely eliminating the chance of concussion in most sports enjoyed by thousands of athletes, coaches, and parents. Education and continued research may help teach us how to decrease the risk though and that might be the goal worth achieving.

Concussions will likely occur but will now be better recognized with improved medical science. The best treatment, that we know of today, is rest- both mental and physical. The best strategy for decreasing catastrophic outcomes is not allowing an athlete to have a second concussion while he or she is recovering from a first concussion.

As a doctor, I have the benefit of many resources to help with this. A CT scanner if needed (and if normally isn't helpful with concussion). Many tools, such as ImPACT (TM), SCAT II, and balance testing are used for diagnosis. Dozens of specialists are at my disposal including physical therapists, athletic trainers, vestibular specialists, neuropsychologists, and on and on. As a parent, or coach, it is no wonder if you feel as though you were given too few resources, possibly even scared that you will do the wrong thing, when you see an athlete, or your son or daughter have a head injury on the field and feel the urgency of "what do I do?"

This article is written for the concerned parent and coach- not medically trained but obviously 100% interested and invested in doing the right thing.

1. If in doubt, sit them out. In the old days, athletic trainers and team doctors would wait 20 minutes and if things seemed ok, put the athlete back in the game. Today, a minimum of 24 hours of no physical activity and a return after a concussion trained doctor has accessed the athlete is recommended if there is even the hint of a concussion. That means after a head impact or whip lash without impact causes headache, confusion, dizziness, light sensitivity, nausea, "fogginess", ringing in the ears, blurred vision, or loss of consciousness (and that is any one of the symptoms- not all!) then remove the athlete from play--- period.
2. Don't think you have to be a trainer- you don't have to know what to ask or what to do- just recognize the athlete who should be removed- your best player on the team is still someone's son or daughter. It's not worth a devastating brain injury, even at the state finals. If you think your athlete had a minor concussion, treat it the same as if he or she was knocked out. It's often not the first concussion that causes the devastating brain injury- it's the second. So remove the athlete after a first, even mild, injury preventing any chance for a second impact.
3. Look for trouble before trouble finds you! A good coach removes a player who has had an obvious concussion complaining of a headache. A great coach listens to his team and realizes that everyone is talking about how "Johnny got lit up and staggered to the wrong side of the field". Johnny may not admit he has a headache but remove that athlete too!
4. Things can get worse before they get better- some symptoms continue to increase the first 2-3 days after a concussion. If you suspect a concussion, tell the parents, document your conversation, and educate the importance of a medical assessment before return to play is permitted.

And if another player, parent, official, or athletic trainer notices one of these things, rather than wait to see if you notice it too, get the athlete out of play. By the time you notice it, the athlete may have a second impact- and the situation may change from something bad to worse.

Related story: Concussion Baseline Studies