If you or your children play sports or participate in outdoor recreation (biking, horseback riding, etc), you may be at risk for a concussion injury. Concussions are mild traumatic brain injuries that occur with direct blows to the head, or by rapid acceleration/deceleration (whiplash) of the head. The Centers for Disease Control has estimated that there are between 1.6-3.8 million concussion per year in the United States from sports and recreational activities.
The changes that occur in the brain during a concussion happen at a cellular level and cannot be seen on standard medical imaging such as CT Scans or MRIs. These changes are thought to include a rapid depolarization (electrical reset) of the brain, which may cause patients to feel “dazed” or even be severe enough to make them briefly lose consciousness. This electrical activity is followed by changes in the brain’s blood flow and pressure regulation, electrolyte transport, and decreased glucose delivery as the brain monitors itself for injury and tries to repair the damage. These blood flow and metabolic changes typically last for 7-10 days and account for many of the “post-concussion” symptoms that patients may feel.
Common symptoms patients may feel during a concussion include a mild headache, lightheadedness, poor balance, fatigue, light sensitivity, mild nausea, or decreased appetite.
Common signs that you may observe in a patient who has sustained a concussion include vacant stares, slowed verbal responses, confusion or disorientation, memory problems, and emotional responses that seem inappropriate or out of proportion for the individual’s normal behavior. 80% of people with a concussion will have complete resolution of these signs or symptoms within 7-10 days.
Signs and symptoms that are concerning and should prompt immediate medical attention at your local physician or ER include prolonged loss of consciousness, focal weakness of a single area of the body, prolonged vision changes, drainage from the ear, severe headache, vomiting, prolonged symptoms beyond 7-10 days, or any symptom that continues to worsen after the initial injury.
There are no medications which have been shown to aid in healing concussions. If the patient is having minor headaches or body aches they may take acetaminophen (Tylenol) but should avoid aspirin, ibuprofen (Motrin), and Naprosyn (Aleve) as these medications can affect how platelet cells form clots, therefore increasing the risk of bleeding in the brain.
It is very important to let the brain rest during the concussion-healing phase. Important things to remember during this time are:
- Get plenty of rest.
- Do not exercise.
- Stay hydrated.
- Eat at regular intervals(do not skip meals).
- Avoid alcohol.
- Avoid playing video games or watching action/intense movies or TV.
During the healing phase of a concussion, the brain is very susceptible to injury in the event of another concussive blow. This is referred to as “Second Impact Syndrome” and can lead to severe injury or death even from a relatively minor blow. Most documented cases of second impact syndrome occur in the 7-10 days after a concussion. Therefore, until patients have recovered from their initial injuries, they should avoid sports and activities that could lead to a second concussion until they are completely recovered from their initial injury. In Colorado, all school athletes must be evaluated by a licensed practitioner (MD, DO, NP or PA) and have a written release prior to returning to sports.
It is also important that the patient returns to normal activity gradually. In the sports medicine programs with which I work, we use standard Return to Play protocols. These involve waiting until the athlete is completely symptom-free from their initial concussion and has fully resumed all academic activities. Patients can then gradually start with mild aerobic activities such as riding a stationary bike. If the athlete is able to do this without any symptoms returning, we will progress through stages of sport specific exercise (dribbling a basketball, shooting a puck etc), non-contact practice/drills, full-contact practice, return to full gameplay. If at any time the athlete becomes symptomatic, they are returned to the previous asymptomatic stage of the protocol. All school coaches in Colorado are required to complete annual concussion education and training.
Many sports and outdoor recreational activities are associated with some inherent risk of concussion. However, rather than avoid activities that bring us health and happiness, we should be aware of and take precautions that will reduce the risk of injury. This may include wearing proper well-fitting activity appropriate protective gear (helmets, mouth guards, etc) and participate in sports under the supervision of educated/trained coaching staffs. When concussions occur, it is important that patients get enough rest and take time to let their bodies heal. Following a gradual return-to-activity protocol will ensure that patients return to optimal levels of health and can continue to enjoy athletics and life in the Colorado outdoors.