MMS Physician Focus: July 2009
by Alan B. Ashare, M.D.
Sports and recreation offer great value and lessons for people
young and old, but the risk of injury is always an inherent danger.
One such risk is concussion, a serious injury that affects millions
of people each year, both on and off the playing fields. With
increased recreation in the summer and as athletes prepare for fall
sports, it's important to remind ourselves about the basics of this
all-too-prevalent injury and the consequences it can
bring.
What is a concussion?
A concussion is a mild traumatic brain injury (MTBI) caused by a
bump or jolt to the head or body. The blow causes the brain to move
quickly inside the skull, which changes how the brain
functions.
What are the consequences?
Concussions can have serious short-term and long-term effects on
health. MTBI can impair thinking, language, learning, emotions,
behavior, and sensations. Recent research with professional
athletes who have sustained multiple concussions has even linked
head traumas to a higher incidence of early dementia.
What are the symptoms of a concussion?
They are many and varied. You don't need to be 'knocked out' to
cause damage; even a mild so-called 'ding' can be serious. Symptoms
include headaches or 'pressure' in the head, confusion, nausea,
vomiting, blurred or double vision, blank stares, ringing in the
ears, slurred speech, loss of balance, sensitivity to light and
noise, personality changes (anger, crying, anxiety), or feeling
groggy or sluggish. These may occur in any combination.
Who is most susceptible to concussion?
Sports and recreational activities cause as many as 3.8 million
concussions each year according to the Centers for Disease Control.
The two age groups most at risk are children up to 4 and
15-19-year-olds. But concussions can happen to anyone, at any age,
at any time. Some 1.4 million people annually sustain a traumatic
brain injury, according to the Brain
Injury Association of America, with 50,000 deaths resulting.
The leading causes are falls (28 percent), motor vehicle accidents
(20), struck by events (19), and assaults (11).
What sports see more concussions than
others?
In high-school sports, football is the leading cause of concussions
for males; soccer, for females. Among youth age 5-18, the five
leading causes of concussions are bicycling, football, basketball,
playground activities, and soccer.
How can you protect against the risk of
concussion?
For sports and recreational activities, follow four steps: (1) wear
a helmet certified for the sport or recreation you're engaged in;
(2) wear a mouth guard, preferably one fitted by a dentist; (3)
stay hydrated by drinking fluids; and (4) for contact sports, be
aware of what's going on around you and don't put your head in
situations that may be dangerous, like tackling head-on in
football. At home, guard against falls by installing hand-rails on
stairs and in bathrooms, securing throw rugs, and tending to ice
and snow in winter. In vehicles, wear seat belts and use head
restraints.
What should you do if you suspect someone has sustained
a concussion?
Seek medical attention immediately. If it occurs in sports, coaches
should remove the athlete from competition at once and have the
individual examined by a physician. Be aware that symptoms can
persist days after the initial injury - a condition called
post-concussion syndrome - and are a sign that the brain has not
yet healed enough to participate in any athletic activity. Coaches
should be guided by the following: When in doubt, sit them
out!
How soon can someone return to normal
activity?
That depends on how long the symptoms persist and how fast
cognitive abilities return. Each case must be determined
individually, especially in sports. Generally, players can return
in one or two weeks, depending on age. More time is required for
younger players. Players should not return to any athletic activity
for a minimum of five to seven days after all symptoms have
disappeared and only then after being cleared by a physician or
certified trainer. Rest is the only known method of treating
concussions.
Where can I find more information?
The Centers for Disease Control has lots of information and free
materials for coaches, parents, and athletes at www.cdc.gov/concussioninyouthsports.
The Massachusetts Medical Society at www.massmed.org/concussion
offers "A Coaches' Guide for Sideline Evaluation" that includes an
evaluation card and thoughts about return-to-play decisions.
Alan B. Ashare, M.D. a physician at St. Elizabeth's Medical
Center in Boston, is chair of the Massachusetts Medical Society's
Committee on Student Health and Sports Medicine and Chair of the
Safety and Protective Equipment Committee for USA Hockey. Physician
Focus is a public service of the Massachusetts Medical Society.
Readers should use their own judgment when seeking medical care and
consult their personal physician for treatment.
