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Helmets on...Its Football Season

Helmets on...Its Football Season:

A Current Perspective on Concussion Presentation and Management

By: Brian Zukowski, PT, DPT

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Whether from football, a fall, or a motor vehicle accident, concussions occur and it’s crucial to recognize symptom presentation and follow the appropriate medical management. October’s blog takes a look at these items to inform those interested in better understanding this injury.

While the context of this blog is centered upon concussions in youth football, the information applies to general concussion presentation.

                                                                                                                              

Early every fall, the sounds of shoulder pads being donned and helmet straps being snapped fill the air of high school locker rooms across the country. Currently , it is estimated that over 1 million high schoolers do just that each year according to the National Federation of State High School Associations. In having such a number of participants in this popular contact sport, the concern of concussions is high and the risk should not be ignored.

During the 2001-2005 time period, it has been estimated that over 200,000 emergency department visits for concussions and other related head injuries were completed each year; this striking number accounted for only sports and recreational injuries in children under the age of 19.1

What is a Concussion?

A concussion is defined as a complex pathophysiologic process that affects the brain and is typically caused by trauma. In most cases, the trauma is either a direct blow to the head or from an indirect blow to the body. Each of these causes can result in a concussion, which can also be defined as a mild traumatic brain injury.2

Symptoms from such an injury can resolve spontaneously, but when symptom presentation persists, it often reflects a functional disturbance to the brain and may include physical, cognitive, emotional, and energy symptoms.

Symptoms of a Concussion

Physical Symptoms (i.e. Body)

  • Headache
  • Nausea
  • Vomiting
  • Balance Issues
  • Dizziness
  • Sensitivity to light and/or noise
  • Visual Problems
  • Numbness or Tingling
  • Neck Pain

Cognitive Symptoms (i.e. Mind)

  • Fogginess or a feeling of being delayed in thinking
  • Difficulties concentrating and/or with memory
  • Changes in taste and/or smell
  • Ringing in the ears

Emotional Symptoms (i.e. Feelings)

  • Irritability
  • Sadness
  • Increase in emotional presentation as compared to baseline
  • Nervousness or Anxiety

Maintenance Symptoms (i.e. Energy)

  • Fatigue
  • Drowsy
  • Noted alteration in sleeping pattern
  • Change in appetite
  • Change in energy level

If Symptoms are Present

If any of the above symptom presentation is noted in yourself or child, it is important to seek appropriate medical attention. In a time of decreased school and sport funding, some athletes may be finding themselves participating in sports without the oversight of a certified athletic trainer.3

Therefore, knowing such information becomes vital to allow yourself to serve as your own health advocate and contact your physician for further evaluation of symptom presentation.

Why you may not want to “Rub Some Dirt on It”

It is important to recognize the documented symptom presentation and ensure a return to sport isn’t considered until full “brain healing” occurs. The old philosophy of rubbing some dirt on “it” following an injury, has no place when dealing with concussions. Currently, research is being completed on what is now recognized as “Second Impact Syndrome.”

What is Second Impact Syndrome?

Second Impact Syndrome occurs when a second concussion is sustained prior to the first concussion having fully resolved. In other words, the brain is injured a second time, when it hasn’t yet fully healed from the first. This can result in rapid and severe swelling, with results sometimes being catastrophic.4

How to avoid Second Impact Syndrome

The answer here is simple, the athlete should not return to sport or contact activities until cleared to do so by a trained medical professional. In recent years, such initiatives and programs as Heads Up Football (http://usafootball.com/headsup) have been developed to allow for coaches to also be educated on concussion presentation and appropriate management.


The Final Whistle - Conclusion Notes

Having played sports throughout my childhood and in high school as well, I believe athletics can serve as a positive experience in the development process of a child. From working with a team to build confidence, the experiences I had will forever be cherished and remembered.

While we all want our children to have fond memories if they too participate  in sports, we should all  have a vested interest in them doing this in a safe manner.

1.  Gilchrist, MD, Julie, Karen Thomas, MPH, Likang Xu, MD, Lisa McGuire, PhD, and Victor Coronado, MD. "Nonfatal Traumatic Brain Injuries Related to Sports and Recreation Activities Among Persons Aged ≤19 Years --- United States, 2001--2009." National Center for Injury Prevention and Control, CDC. 7 Oct. 2011. Web. 29 Aug. 2015.

2.  "Traumatic Brain Injury in the United States: Fact Sheet." Centers for Disease Control and Prevention. Web. 25 Aug. 2015.

3.  Waxenberg, Robin, and Ellen Satlof. "Athletic Trainers Fill a Necessary Niche in Secondary Schools." National Athletic Trainers' Association. 12 Mar. 2009. Web. 29 Aug. 2015.

4.  "Second Impact Syndrome." Brainandspinalcord.org. Web. 29 Aug. 2015.

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