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Health and Safety

What is a concussion? 
A concussion is a disturbance in brain function that occurs following either a blow to the head or as a result of violent shaking of the head. 

How many sport-related concussions will occur this year? Experts are predicting that a few hundred thousand concussions are expected to occur this year alone. 

What are the chances that my child will sustain a concussion? 
One in 10 high school athletes involved in contact sports sustains a concussion each year.

When is a head injury more than a concussion? Most athletes recover relatively quickly from injury. However, the physician or other health professional should be aware of the warning signs of more severe injury. Transport a player immediately to the ER if he or she displays any of the following symptoms or signs: any penetrating injury to the skull any loss of consciousness very severe headache that continues to increase in intensity (a CT scan may rule out bleeding or brain swelling) a pronounced decline in mental status in the minutes to hours following injury sensory or motor loss in the limbs persistent vomiting, particularly when accompanied by severe headaches 

What symptoms indicate that an athlete has sustained a concussion? Concussed athletes experience a wide variety of symptoms. Seek medical attention if your player experiences any of the following symptoms: Gross confusion Clumsiness Amnesia Loss of Consciousness (LOC) Inappropriate laughter or crying Headache Nausea Sluggishness Feeling foggy Double or fuzzy vision Concentration or memory problems Changes in sleep patterns The diagnosis of concussion can be tricky under the best of circumstances. There may be no direct trauma to the head, and the concussed athlete is often not rendered unconscious. The athlete may be unaware that he or she has been injured immediately after the injury and may not show any obvious signs of concussion. To complicate this situation, athletes at all levels of competition may minimize or hide symptoms in an attempt to prevent their removal from the game, thus creating the potential for additional injury. 

When is it safe for the concussed athlete to return to play? In November 2001, the 1st International \Symposium on Concussion in Sport (CIS) was held in Vienna, Australia. This symposium was organized by the International Ice Hockey Federation (IIHF), the Federation Internationale de Football Association Medical Assessment and Research Centre (FIFA, F-MARC), and the International Olympic Committee Medical Commission (IOC). The aim of the symposium was to provide recommendations addressing this important topic for the improvement and safety and health of athletes who summer concussive injuries. To this end, a range of experts were invited to address specific issues of epidemiology, basic and clinical science, grading systems, cognitive assessment, new research methods, protective equipment, manage3ment, prevention, and long-term outcome, and to discuss a unitary model for understanding concussive injury. At the conclusion of the conference, a small group of experts were given a mandate by the conference delegates and organizing bodies to draft a document describing the agreement position reached by those in attendance at that meeting*. * position statement verbatim - printed Clinical Journal of Sports Medicine 2002 As outlined below, the CIS recommendations allow return to play following both the absence of symptoms at rest and following exertion and normal neuropsychological testing results. Athletes should complete the following step-wise process prior to returning to play: Removal from competition following observation or reporting of signs/symptoms of concussion No return to play in current game Medical evaluation following injury Rule out more serious skull fractures or bleeding in the brain Neuropsychological testing considered "cornerstone" or proper post-injury assessment Step-wise return to play No physical activity: rest until asymptomatic Light aerobic exercise Sport-specific training Non-contact drills Full-contact drills Game play Wait 24 hours, in most cases, between steps. However, any recurrence of concussive symptoms should lead to the athlete dropping back to the previous level. If an athlete is asymptomatic at rest and develops a headache following light aerobic exercise, the athlete should return to complete rest. 

Does age matter for recovery time? In the first published study to examine age as a factor, University of Pittsburgh Medical Center (UPMC) sports concussion researchers found that high school athletes demonstrated prolonged memory dysfunction requiring longer recovery compared to college athletes. According to principal investigator and neurosurgeon Dr. Melvin Field, "Our finding that high school athletes did not recover from concussion as quickly as college athletes is a cause for concern because the largest majority of at-risk athletes are at the high school level or below." 

What are the consequences of sustaining multiple concussions? There is NO debate that repeat concussions significantly worsen long-term outcomes. After athletes sustain one concussion, they are three times more likely to sustain a second concussion compared to other players who have not been concussed. Repeat concussions, even when mild, can increase the risk of post-concussive symptoms (PCS) such as headaches, memory loss, difficulty concentrating, etc. Chances of PCS are even more increased if the second injury occurs too soon, before recovery from the first has taken place. The higher the rate of concussions, the higher the risk of long-term cognitive dysfunction. 

What is Second Impact Syndrome (SIS)? Second Impact Syndrome (SIS) refers to the catastrophic events which may occur when a second concussion occurs while the athlete is still symptomatic and healing from a previous concussion. The second injury may occur anytime from days to weeks following the first. Loss of consciousness is not required. The second impact is more likely to cause brain swelling and other widespread damage and can be fatal. 

What can a coach do to help prevent concussions? Even in contact sports, some concussions may be prevented by teaching and executing proper playing, tackling and defensive techniques, and by wearing properly fitted equipment, especially helmets.