There has been significant talk about the safety of sports, especially football, in recent years. Concussions have headlined the news and have been the focus of much of the discussion. But what exactly is a concussion and what should you do if you or your athlete experiences one?
What happens to the brain during a concussion?
Most concussions occur when a person is hit in the head, hits their head on the ground (or something else), or there is a whiplash motion causing the head to move quickly from one direction to the other. Concussion can occur during collisions in sports, but also car accidents, falls, or even hitting your head on an open cupboard door.
During these incidences, the brain moves inside the skull, stretching the membranes and neurons. When this happens, there is a long chain of events that follow within the brain cells. Cell structure is damaged at times and the signals that normally travel through the brain cells don’t transmit. Because of the imbalance of chemicals in the cells, there is what is called a "crisis period" in the brain as the cells try to pump the chemicals back out. This takes a lot of energy from brain, which makes other functions not work as well. This is why a wide variety of symptoms show up at the time of injury and while the brain continues to heal. This is just a very simplistic view of a very complex process.
What are the symptoms of a concussion?
During this crisis period, it is important to avoid getting hit in the head again and to rest physically and mentally. Immediately following, and through the recovery, there are various signs and symptoms that may be present. Common symptoms include headaches, pressure in the head, nausea, dizziness, double vision, sensitivity to light and sound, feeling sluggish, foggy, groggy, clumsy, behavior changes, amnesia, appearing dazed, and others. There are also changes in memory, reaction time, balance and coordination. Symptoms may take hours to develop so a concussion is not always obvious at the time of the injury. You do not have to be knocked unconscious to have a concussion. In fact you don’t even need to experience a significant hit. It just needs to be the right (or wrong) hit.
The good news is, with appropriate care, about 40% of people feel better in 3 days; 80-90% are symptom free in 7-10 days. Kids may take 10-14 days to recover. As a general rule, recovery in females tends to take longer than males. Recovery is variable, but the majority of people are able to return to a normal, symptom-free life.
Who is more likely to get a concussion?
Concussions can happen to anyone at any time given the right circumstances, but those in athletics tend to put themselves at a higher risk. Some research shows there are between 1.6 and 3.8 million sport-related concussions (SRC) per year. This number has been growing over the past few years, but many relate this to increased and improved reporting of the injury.
Rates of concussions are difficult to track, but most of the recent research shows that the sport with the highest rate of concussions (per exposure) is rugby, followed by ice hockey, football, lacrosse, soccer, and wrestling.
According to research presented at the 2017 Annual Meeting of the American Academy of Orthopaedic Surgeons, high school girls have a significantly higher concussion rate than boys. In gender matched sports (soccer, basketball, baseball/softball), females had a significantly higher rate of concussions than boys. From 2010 to 2015, the concussion rate (number of concussions compared to the total number of injuries reported in that sport) was higher in girls soccer than boys football.
How can physical therapy help?
At 21st Century Rehab, PC, we provide sports medicine coverage to many of our local high schools. This includes assessment and treatment of all sports injuries, including concussions. In order to provide such care, our staff has undergone extensive training to provide the highest level of education and concussion management. Students are given baseline tests prior to the start of the season, and, in the case of a suspected concussion, are able to lead them to a full recovery.
What does recovery look like?
Return to sport, a process used by our sports medicine staff, is a stepwise process based on the latest research. Once the diagnosis is made, and the likelihood of a more serious problem has been ruled out, the initial step is complete rest. Mental and physical rest is a crucial step in the process. Student-athletes are to do as little as possible for the first 24-48 hours. This means minimizing cell phone use, TV, social interaction, and absolutely no video games. After that time, the student can begin walking or riding a stationary bike for activity, as long as it does not significantly worsen his or her symptoms.
Once there are minimal symptoms at rest, the student can return to school. Recent legislation in Iowa has made return to learn (school) the primary focus of recovery. Our sports medicine staff helps guide the student, teachers, and administrators as the student gradually returns to a full day of school. Once that happens, the athlete can progress into a 5-stage return to activity protocol, gradually increasing activity and intensity in practice.
Before a student athlete can return to a game, the athlete must pass all clinic tests including vision, balance, memory, activity tolerance, and neurocognitive tests. At 21st Century Rehab, we use the ImPACT test, the only FDA approved neurocognitive concussion test, with all athletes that have sustained a concussion. Once an athlete has been fully cleared, the final step is parental approval of return to play. There is currently no “magic number” of concussions that an athlete can have before they need to stop playing. Each situation is unique and requires guidance from an objective person educated in concussions.
If you have any questions about concussions, contact your local 21st Century Rehab office for more information!