Concussions in Sports

Presented by: Matt Brennan, ATC/AT-L

“….just got their bell rung” 300,000 sports concussions per year 1.6 to 2.3 million sports concussions per

year (CDC 2006)

16 deaths in youth sports since August 2008, 6 head injury related

36 concussions in SHS athletics during the 2008-2009 school year

What is a concussion?

A complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces.

Caused by a blow or jolt to the head that disrupts the function of the brain.

In concussions acute clinical symptoms largely reflect a functional disturbance rather than a structural injury. (Zurich Consensus Statement 2009)

What is a concussion?

Complex --- no “easy” concussion Pathophysiological--- not structural! Trauma Induced--- impact to the head Less than 10% of all concussions

involve a loss of consciousness.

Pathophysiology

In a concussion, certain chemical levels are altered at the cellular level

Blood supply to the brain decreases The brain’s demand for glucose increases

The result is a metabolic imbalance referred to as an “energy crisis”

The supply/demand mismatch can last days. (Giza,

Hovda J Athl Training 2001)

If your brain is a computer….

Then a concussion is a software issue, not a hardware problem

Imaging (X-ray, CT, MR, etc) shows structure not function

Imaging will be normal in most cases Normal Imaging ≠ Normal Function! Most concussions have Normal Imaging!

Concussions-Not Just a Football

Problem…. Concussion rate per 1000 athlete-exposures

Football 0.47Girls Soccer 0.36Boys Soccer 0.22Girls Basketball 0.21Boys Basketball 0.07

Most injuries occur in football players due to the large number of participants

Gessel LM et al. “Concussions Among United States High School and Collegiate Athletes” Journal of Athletic Training 2007; 42:495-503

60% Higher

300% Higher

Signs and Symptoms COGNITIVE SOMATIC AFFECTIVE SLEEP

ConfusionPost-Traumatic Amnesia (PTA)Retrograde Amnesia (RGA)Loss of Consciousness (LOC)DisorientationFeeling “in a fog”, “zoned out”Vacant StareInability to focusDelayed verbal and motor responsesSlurred/incoherent speechExcessive drowsiness

HeadacheFatigueDisequilibrium, dizzinessNausea/VomitingVisual disturbances (photophobia, blurry/double vision)Phonophobia

Emotional liabilityIrritability

Sleeping more than usualSleeping less than usualTrouble falling asleepDrowsiness

Recognizing a Concussion

Signs observed by coach, parent, teammates

Appears dazed or stunned Is confused about assignment Forgets plays Is unsure of game, opponent, or

score Moves clumsily Answers questions slowly Shows behavior or personality

changes Loss of consciousness Can’t recall events prior to the hit Can’t recall events after the hit

Symptoms reported by the athlete

Headache Nausea Balance problems or

dizziness Double or fuzzy vision Sensitivity to light or noise Feeling sluggish Feeling foggy Concentration and/or memory

problems Confusion

I Suspect My Athlete has Sustained a Concussion…

Now What?

The Law…

EHB 1824---Zackery Lystedt Law

Signed May 14, 2009

Zackery Lystedt Law, EHB 1824 Parents and athletes must sign an information sheet

about head injuries prior to beginning participation in athletics each year

Requires that any youth athlete suspected of having a concussion be removed from practice or play

Any athlete suspected of suffering a concussion is removed from play until they receive written medical clearance from a licensed health-care provider trained in the evaluation and management of concussions.

http://apps.leg.wa.gov/billinfo/summary.aspx?bill=1824&year=2009

When a concussion is suspected Remove the athlete from practice or play

IMMEDIATELY! If there is a school approved licensed health

care provider trained in the management and evaluation of a concussion available they should provide care for the athlete

When a concussion is suspected If there is no school approved licensed health

care provider available it is the coaches job to continually evaluate and reassess the athlete

Never leave the athlete unsupervised by a member of the coaching staff

Inform the athletes parent/guardian of the suspected injury

If the athlete worsens, call 911 If the athlete is stable, release them to their

parent/guardian

When can an athlete return to play?

Youth athletes should not be returned to play on the same day as injuryThe younger the athlete the more conservative the treatment

REST is BEST! This is both physical and cognitive rest

Every athlete is different and there is no set timeline for their return to activity

Athletes will follow a gradual multi-stage return to play protocol once they are symptom free and all of their exams have returned to normal

Catastrophic Head Injuries in High School and College

Football Players National Center for Catastrophic Sports Injury

Research data from 1989-2002 94 cases 92 cases were in high school players 59% of athletes had a previous history of

concussion(s):71% of those injuries occurred in the same season as the

catastrophic injury 39% of the athletes at time of catastrophic injury were

playing with residual symptoms from a previous concussion

Boden et al. AJSM 2007; 35: 1075 - 1081

Risk of Early Return to Play Intracranial Bleeding----can lead to death Second Impact Syndrome---can cause

death Multiple Concussions Longer Recovery Period Post-Concussion Syndrome Permanent Brain Damage

Gradual Return to Play

The athlete should be completely symptom free to begin this process

There should be 24 hours between each stage

The athlete must be asymptomatic in each stage

If symptoms return at any time, they must stop and rest for a minimum of 24 hours and be symptom free before restarting return to play protocol back at stage 1

Gradual Return to Play Steps:

No activityLight aerobic activitySport-specific activityNon-contact training drillsFull contact practiceFull return to play

This process takes at least 1 week to return an athlete to play

SHS/MS Head Injury Protocol ImPACT baseline testing If a head injury occurs:

No same day return to playEvaluation will be done by AT/L and the athlete will

be evaluated by a physicianAthlete will re-test using ImPact 24-48 hours after

the injuryAthlete will begin the return to play protocol when

they are symptom free and have returned to baseline on all testing

SHS/MS Head Injury Protocol If a head injury occurs:

If the AT is not present do not leave the athlete unsupervised

If they are stable contact their parents and have them pick them up and take them for further evaluation

If they are not stable, call 911Contact the AT to notify of the injury so that it can

be followed up on the next day

Is This Practice/Game More Important Than:

The rest of the season?

The rest of the athlete’s career?

The rest of the athlete’s life?

Finally

Do not let an athlete suspected of having a concussion back into practice or games until

they have been evaluated and cleared in writing by a Licensed Health Care Provider

trained in the management and evaluation of concussions.

That is not only the LAW;

It Is the Right Thing To Do!

Resources

Heads up kit: www.cdc.gov/concussioninYouthSports/

www.biawa.org www.nata.org www.seattlechildrens.org www.wiaa.com

Thank You!