Ask a Vail sports doc: sports related concussions
Ask a Vail sports doc
Fall sports season has started and with it come an increased number of concussions. In recent years, there has been improved awareness of sports related concussions.
A basic definition of a concussion is an alteration of brain function, typically short lived, which occurs due to a biomechanical injury to the brain. Athletes who have suffered an acute concussion commonly experience headache, blurry vision, dizziness, confusion and in 10 percent of concussions a loss of consciousness.
Later signs and symptoms of concussion include fatigue, sleep disturbances and difficulty concentrating.
It is estimated that more than 2 million concussions occur each year during sports. Approximately 25 percent of athletes who have sustained a concussion fail to seek medical treatment.
The biggest risk for a concussion is an athlete who has sustained a prior concussion. Concussions are most common in athletes ages 10 to 20. Sports such as football, hockey, soccer, skiing and snowboarding pose larger risks for concussion. Female athletes in these sports have a higher rate of concussion than their male counterparts.
What is it?
A concussion occurs when the brain experiences sudden linear or rotational forces such as with a collision.
These forces stretch the brain cells, called neurons, and injures the neuron’s cell wall. This sets off a cascade of physiologic events which result in decreased blood flow to the brain, electrolyte abnormalities in and around the neurons and resultant neuron dysfunction. The acute phase of a brain injury can last for several weeks.
Most importantly, during this acute phase the brain is more vulnerable to a second concussion, which can lead to an even greater brain injury. The so-called second impact syndrome can result in severe brain swelling, neurologic loss and even death.
If an athlete is injured in sport and a concussion is suspected, the athlete should be immediately removed from the field of play. If a medical professional is present, they may administer the Sport Concussion Assessment Tool. As for returning an athlete back to play immediately after a suspected concussion, the adage “When in doubt, sit them out” should be applied.
What to do
An athlete with a mild concussion can return home with their family. Ice and Tylenol can be used to treat the headache. NSAID’s or aspirin should be avoided in the first 48 hours as these increase bleeding risk. A mildly concussed athlete can sleep without being awoken for periodic checks.
If at any point, an injured athlete demonstrates a decreased level of consciousness, worsening headaches, the onset of vomiting or seizures, then they should be taken to the emergency room for further workup, which will probably include a CT scan of their head.
Mild or moderate concussions are otherwise treated with rest, both physical and cognitive. Most of these injured athletes should be recovered in two to three weeks.
A neuropsychological test such as the IMPACT test may be used as a guideline to help determine when an athlete might be able to resume playing sports.
There are also standardized return to play protocols that are used for concussed athletes.
Dr. Rick Cunningham is a knee and shoulder sports medicine specialist with Vail-Summit Orthopaedics. He is a physician for the U.S. Ski Team. For more information, visit his website at http://www.rcunninghamorthopedcis.com or to learn more about Vail-Summit Orthopaedics, visit http://www.vsortho.com.