Concussions. You hear about them almost every day in the world of sports. They can affect athletes of all ages- young and old, and their numbers are on the rise. Recent studies have shown that the number of concussions have more than doubled over a 5 year span in children, ages 8-13. It is estimated that there are between 1.6-3.8 million sports related concussions occurring each year. Five percent of those head injuries came from the sport of soccer. The majority of concussions in soccer are the result of a collision with another player, an object, or the ground. Studies have also shown that there is a very low occurrence of concussions associated with heading the ball. The facts can be overwhelming for sure; but with proper education I feel it’s possible to get through this potentially dangerous injury as smoothly as possible. Knowledge is power. My goal is to give you the ability to recognize the common signs of a concussion and seek proper medical assistance when necessary, to ensure a SAFE return to the soccer field.
A concussion can be defined as any blow to the head, body, or fall that disrupts normal brain function. Your brain is a soft organ that is surrounded by spinal fluid and is protected by the skull. The fluid acts as a cushion to keep the brain safe inside the skull. When you take a hard enough blow to the head, the brain can “crash” into the skull, causing damage. This can lead to bruising of the brain, tearing of blood vessels, and injury to the nerves.
Concussions can be difficult to diagnose because symptoms can be subtle and may not show up for hours or even days after a head injury. They are graded on the severity of the symptoms the athlete is experiencing. Some organizations have created as many as 5 different levels or grades for a concussion; but for the most part they fall into 2 categories- simple and complex. A simple concussion is one that all symptoms have gotten better in 7-10 days. A complex concussion is one that the athlete experiences persistent symptoms lasting longer than 2 weeks. An athlete is automatically placed in the complex category if he/she loses consciousness for more than 1 minute or has had a prior head injury regardless of how long ago it occurred. Unfortunately, once someone has had a concussion, they are 2-3x more likely to sustain another one.
As I stated before, some symptoms can be subtle and others can be very obvious. Some may be seen right away, while others may take some time to develop. The important thing to remember is if your child is experiencing any of the following symptoms, seek medical attention from someone who is trained in the diagnosis and management of concussions. The following is a list of common signs and symptoms of a head injury.
- Appears dazed or confused
- Headache or "pressure" in head
- Confused about position
- Nausea or vomiting
- Forgets an instruction
- Balance problems or dizziness
- Unsure of game, score, or opponent
- Double or blurry vision
- Moves clumsily
- Sensitivity to light
- Answers questions slowly
- Sensitivity to noise
- Loses consciousness (even briefly)
- Feels sluggish, hazy, foggy, groggy
- Shows mood, personality, behavior changes
- Concentration or memory problems
- Confusion
- Can’t recall events prior to hit-Retrograde Amnesia
- Can’t remember events after hit-Anterograde Amnesia
- Doesn’t feel “right” or “feeling down.
Earlier this year in July, Governor Pat Quinn made Illinois the 28th state to sign comprehensive legislation on the management of concussions. This new law, House Bill 200, “ensures that athletes who receive a concussion will not be allowed to return to play or practice until they are evaluated and receive written clearance from a licensed health professional.” This physician should be a specialist in concussion treatment and management. The Illinois Youth Soccer Association, a member of US Youth Soccer, has followed the Center for Disease Control’s protocol for management of head injuries. It too states that no athlete will be allowed to return to soccer without a release from a physician trained in the management of head injuries. It’s reassuring to see that head injuries are no longer being taken lightly and proper medical care is essential for safe return to play.
Once at the doctor’s office, he/she will ask about the injury- how it happened and what symptoms are currently present. They may ask what seems to be “silly” questions, What day is it? or Who is the President? This is to check the level of consciousness and memory/concentration abilities of the athlete. A thorough exam of the nervous system will also be done. This will look at balance, coordination of movement, and reflexes. If the doctor feels it is necessary, he/she may order a CT scan or MRI to check for bleeding or other injury to the brain. If a head injury is confirmed by the physician, the treatment of choice is rest, with avoidance of any activity that increases symptoms being a must. The goal is to have complete resolution of symptoms before the athlete is allowed to return to the field.
After symptoms have fully subsided and the physician has given written permission to return to full activities, returning to the field should still be a slow process. A gradual return-to-play protocol has been developed by a panel of international experts to aide in this process.
Day 1: Light aerobic exercise (walking, swimming, or stationary bike) keeping exercise heart rate less than 70% of maximum predicted heart rate. Maximum predicted heart rate is calculated by: 220- age and then multiplying that number by 70%.
Day 2: Sport specific exercise, any activities that incorporate sport-specific skills, i.e. running in soccer. NO head impact activities.
Day 3: Non-contact training drills.
Day 4: Full contact practice, participate in normal practice activities.
Day 5: Return to competition.
If ANY concussion symptoms return during any of the above activities, the athlete should return to the previous level, AFTER resting for 24 hours.
I have included the CDC Heads Up concussion information sheets for coaches, parents, and athletes. Please print them and keep them on hand in case there is ever a suspected head injury to your child. If there are any questions about any of the information that was just presented, please send an email and I will get back to you as soon as possible. Remember, WHEN IN DOUBT, SIT OUT!
