Special Caution on Concussions
Concussions occur frequently among athletes, but they are the type of sports injury that we know the least about. Experts say that's because of the brain's complexity, as well as a lack of research into concussions.
Concussions -- defined as a trauma-induced alteration in mental status -- are often difficult for doctors to recognize.
"In fact, the majority of concussions do not involve loss of consciousness," says James P. Kelly, M.D., an associate professor at the Chicago Neurological Institute. You don't even have to be hit on the head. A blow to the shoulder that violently snaps the head can cause a concussion.
Athletes ages 14 to 24 are most prone to concussions, Dr. Kelly adds. They're big enough to deliver damaging blows and sensitive to injury because their brains are still developing.
Athletes often fail to appreciate the seriousness of concussions.
"In the past, guys would take a shot and couldn't remember what the score was and it was considered part of the game," says Edward M. Wojtys, M.D., a University of Michigan team physician. "Now they are 35 and 40 years old and they are having problems with some of their cognitive functions, they are having problems doing their job, and we are wondering if this has anything to do with concussions."
Dr. Kelly cites a 17-year-old football player who died of brain swelling after suffering two concussions in two weeks. "He was given the message that he should fight through [the first concussion], and he bought into it.''
Head injuries are most common in contact sports, but protective equipment can limit the risk. A helmet reduces the force of contact and slows the impact to the brain. "It's like putting an air bag on your head," Dr. Kelly says.
Unfortunately, helmets can give athletes a sense of invulnerability. "You see kids doing things with their helmet in place that they would never do without a helmet," Dr. Wojtys says.
Soccer isn't risk-free, either. Children "have no business 'heading' the ball until they are in their mid-teens," says Dr. Kelly, though he thinks flying elbows, kicked balls or collisions may pose bigger threats to unprotected heads.
A good rule of thumb is: one concussion you are out of the game, two concussions you are out for the season, and three concussions, you should no longer be participating in the sport.
Rest is the only treatment for a concussion. The brain needs time to repair itself.
Often athletes experience no symptoms after a few days. But headaches, nausea and other problems may return from plunging back into sports too soon.
Other rules of treatment:
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Immediately after injury, a physician or trainer should evaluate the person's mental status.
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Remove the person from the activity, especially after loss of consciousness, for at least a week. "There are physicians who still send an athlete back into the same contest in which they were rendered unconscious," Dr. Kelly says. "There is no way, in my opinion, that should happen."
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Monitor state of consciousness closely for 24 to 48 hours.
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Restrict activity.
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Gradually return to light activity. Rest more if symptoms recur.
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Once past all symptoms, allow at least three to five days away from the activity -- more for children.
We need more research on concussions, experts agree. Having had one concussion increases your risk for a second, and may cause slower recovery from the second one if it occurs. "Athletes are bigger, stronger and faster these days," Dr. Wojtys says. "They are capable of causing much greater trauma than in the past."
Signs of a concussion
Although symptoms may not occur immediately, common signs include: