Worry About All Blows to the Head

Sports-related concussions in young athletes frequently go unrecognized, and often do not receive proper respect for the potential seriousness that even a mild injury may have, says Mark Halstead, M.D., an instructor of orthopaedic surgery and of pediatrics at Washington University School of Medicine in St. Louis and a pediatric sports medicine specialist at St. Louis Children's Hospital.

With more high-profile athletes describing their postconcussive symptoms, awareness is at an all-time high. An explosion in research about concussions in the past five years has increased understanding of how serious concussions may be.

“There is a common misconception that an athlete only has a concussion if he or she loses consciousness,” says Halstead. “In fact, most athletes may only suffer from a mild headache or feeling confused or foggy. Concussions may even occur without impact, from the head being shaken.”

Common symptoms of a concussion include:
• Headache
• Dizziness
• Changes to the vision such as blurry vision or double vision
• Upset stomach or vomiting
• Feeling tired
• Moodiness
• Confusion
• Loss of memory of events before and after the concussion

It is important for coaches, parents and athletes to recognize the symptoms of a concussion because athletes may only have one symptom, Halstead says. No athlete should be returned to play while still experiencing symptoms of a concussion.

“One reason not to return a player to the field while symptomatic is the possibility of second-impact syndrome,” explains Halstead. “This condition has only been observed in younger athletes. If an athlete has a second impact to the head, while still recovering from the effects of a first concussion, there is potential for massive brain swelling, which can lead to death. There is controversy as to whether this syndrome actually exists because it is rare. However, it certainly can be prevented by not returning an athlete to an event prematurely.”

Recent research has demonstrated that athletes who have what are commonly considered mild concussions, or "dings," may no longer experience headaches or other symptoms of concussions but still show significant deficits in processing information. This can last up to seven days postconcussion. As a result, several computerized neuropsychological testing programs have been developed to help assess for these deficits rapidly through a CT scan or MRI brain imaging.

Halstead said a newer concept in treating concussions is concussion rehabilitation. This involves a gradual approach to bringing the athlete back to the playing field.

“Since concussions are an injury to the brain, the biggest difficulty athletes have after a concussion is in processing information,” he says. “It may be helpful to have the athlete avoid mentally challenging activities during his or her rehabilitation, which may even include a brief break from classes and school work. Once an athlete is symptom-free, he or she can progress through increasingly heavy exertion to ensure he or she does not experience a return of symptoms.”