Concussions

By John Smith MS, PT, Cert. MDT

There is no doubt that one of the bigger topics in football is concussions. Every year when football season begins the concern for concussions is once again in the spotlight. In the last few years we have seen and are seeing more and more coverage and attention given to concussions in football players. ESPN aired a recent episode on concussions in high school football players which included one of our own local high schools - Schlagle.  You may also remember the tragic death of a high school football player from Spring Hill whose cause of death was a “second impact syndrome”, in which there is an impact to the brain before a concussion has healed.  It is obvious that the media and the public are paying closer attention and are more aware of the risks for concussions, but are we as athletes, parents and coaches taking them seriously? It isn’t just the athletic trainer’s job to recognize the signs and symptoms for a concussion.  It is imperative that all coaches, all players and even the parents learn the signs as well.

What are the signs and symptoms of concussion? Based on the Kansas State High School Activities Association there are both signs and symptoms that we should learn to recognize.  

Signs Observed by others                                            Symptoms reported by the athlete

Appears dazed or stunned                                           Headache

Is confused about assignment                                    Nausea

Forgets plays                                                                      Balance problems or dizziness   

Is unsure of game, score, or opponent                   Double or fuzzy vision

Moves clumsily                                                                 Sensitivity to light or noise

Answers questions slowly                                            Feeling sluggish

Loses consciousness                                                        Feeling foggy or groggy

Shows behavior or personality changes                   Concentration or memory problems

Cannot recall events after hit                                     Confusion

Cannot recall events prior to hit


It is important that athletes, coaches and parents don’t take these signs and symptoms lightly. Recognizing a concussion early could drastically change the outcome of an athlete’s life and career. Once any of these signs or symptoms have been recognized, the athlete should be removed from the game immediately. Once a player has been removed from a game with suspicion of concussion then the player must go through a certain criteria of requirements for clearance to return to the sport. The Kansas State High School Activities Association return to play or practice clearance requirements are as follows:

A.      The clearance must be in writing and signed by a health care provider

B.      The National Federation and the KSHSAA recommend the clearance should not be issued on the same day the athlete was removed from the game.

C.      The National Federation and the KSHSAA recommend that a student who has been removed from a practice or competition because the student suffered, or was suspected of suffering, a concussion or head injury should complete a graduated return to play protocol following medical clearance before returning to unrestricted practice or competition.


If a player has been diagnosed with a concussion his doctor may recommend an Acute Concussion Evaluation (ACE) Care plan which may require as mentioned above, a gradual return to play protocol. Depending on the clearance allowed by the doctor, the protocol may be administered by a coach, physical education teacher or athletic trainer. If the athlete is not allowed to participate in practice or PE at school, the school may require that the student begin the ACE care plan outside of school. In these cases the athlete may have a few options, such as contacting an athletic trainer or physical therapist. Once the athlete has passed steps 1-3 with no reoccurring symptoms, he or she may be released to return to full contact, but still needs to complete steps 4-5 with no symptoms. Once all steps have been completed without reoccurring symptoms the athlete will be released by the doctor. Keep in mind that if the athlete has any symptoms of concussion at anytime during the ACE care plan, then they must discontinue all activity and be re-evaluated by their health care provider.


Return to sport steps:

1.       Light aerobic exercise – 5 to 10 minutes on an exercise bike or light jog; no weight lifting, resistance training, or any other exercise.

2.       Moderate aerobic exercise – 15 to 20 minutes of running at moderate intensity in the gym or on the field without a helmet or other equipment

3.       Non-contact training drills in full uniform. May begin weight lifting, resistance training, and other exercises.

4.       Full contact practice or training

5.       Full game play

What it really comes down to is that our athletes’ safety comes first. We need to understand that even if we are playing in the most important game of the season, nothing is worth the chance of suffering a second impact injury that could lead to a life threatening situation. It is also important to know that concussions don’t just happen to football players, but to players of many other sports as well. In fact, recent studies have shown that women’s soccer has now become the second leading sport for concussions in all athletes.

Take home points:

·         If you suspect a player has a concussion, remove them from the game immediately

·         Everyone should know the signs and symptoms of a concussion

·         If you have symptoms, see your health care provider and make sure to go through all of the steps mentioned above before returning to the sport.


References:
Goldstein, Dr. Randall. "Concussions Part II." Advanced Athlete Sept. 2012: 10-11. Web

Kansas. Kansas State High School Activities Association. Kansas State High School Activities Association Recommendations for Compliance with the Kansas School Sports Head Injury Prevention Act and Implementation of the National Federation Sports Playing Rules Related to Concussions. N.p.: KSHSAA, 2011. Web. 8 Oct. 2012. <http://www.kshsaa.org/Public/PDF/KSHSAA%20Concussion%20Guidelines2011-12.pdf>.

McCrory, P., W. Meeuwisse, K. Johnston, J. Dvorak, M. Aubry, M. Molloy, and R. Cantu. "Consensus Statement on Concussion in Sport - the 3rd International Conference on Concussion in Sport Held in Zurich, November 2008." SAJSM 21.2 (2009): 36-46. Web.

John Smith MS, PT Cert. MDT is a Physical Therapist and the clinic director at Preferred Physical Therapy (www.kcppt.com) located at 8437 State Ave KCK. He specializes in orthopedic injures and his professional interest include spine rehab, injuries of the shoulder and knee, sports injuries, running injuries and post operative rehab.