Concussions

Concussions are, once again, a hot topic this year. Every year, it seems as if a high profile NFL player is diagnosed with a concussion. Questions arise almost instantaneously as people ask, "How did it happen?", "Could it have been prevented?", and "When will he be back to play?"

Football at any level has certain risks that the players must assume but hopefully when they are injured they will get proper medical attention. Guidelines for grading and dealing with concussions can be varied and confusing if you review the medical research.

The first hurdle that a medical staff must cross is the actual diagnosing and grading of the concussion. Not all players will divulge that they have been injured and to their defense they might not understand how to then communicate their injury to a medical personnel.

Grading the concussion is confusing because the many different scales, this can lead to confusing and misdiagnosing the head injury. It is important for a medical staff to have set grades and guidelines that can be used when necessary.

An example of grades that is easy to understand and follow is listed below.

GRADE 1 (mild): Confusion without amnesia and no loss of consciousness

GRADE 2 (moderate): Confusion with amnesia and no loss of consciousness

GRADE 3 (severe): Loss of consciousness

Once the head injury has occurred guidelines for return to competition are then needed to be implemented. An example is listed below.

GRADE 1 (mild): The athlete might state that they had "their bell rung" or "their clock cleaned."

They should be removed from competition and examined immediately on the sidelines and re-examined every 5 minutes for development of post concussion symptoms. The athlete may return to competition if there is no amnesia or no other symptoms appear after 15 minutes.

GRADE 2 (moderate): The athlete will be confused and may not remember the play he was injured on or even who he is playing against. This athlete should be removed from competition and not allowed to return during that game. They should be examined and re-examined frequently on the sidelines for worsening symptoms. They should be examined the following day and if appropriate the treating physician may then order any special tests to be done (MRI, CAT scan). The athlete can return to competition after one week of being asymptomatic at rest and with activity.

GRADE 3 (severe): The athlete will have loss of consciousness. They should be held out of competition for 1 month and be asymptomatic at rest and with activity.

Sideline mental testing is an important factor in the diagnosing of the injury, they help in grading and for allowing or disallowing the player to return to competition. Listed below are examples of questions that medical personnel can ask athletes during competition.

Orientation
Is the player oriented to time and place?

• What team are you playing?
• Where are you?
• What day is it?

Concentration
Is the player able to concentrate and problem solve?

• Recite numbers or words forwards and then backwards.

Memory
Is the player able to remember people or places?

• Who is the President?
• Where is the White House?

Exertion Provocative Tests (Physical Testing)
Is the player able to do exercises without his symptoms getting worse?

• Sideline running
• Push-ups
• knee bends

Neurological Tests
Is the player responsive or show any signs of neurological damage?

• Pupil symmetry and pupil reaction; as the athlete opens and closes his eyes watch for pupil symmetry and reactions.
• Coordination; finger to nose test; watch for coordinated movement.
• Sensation; with athletes eyes closed examine their sensation to sharp and dull objects.

Minor head injuries are more common than severe head injuries in sports. When a player does suffer a concussion he is more likely to sustain another concussion if he is not properly evaluated and treated.

Medical staffs must be able to deal with athletes properly once the injury has occurred, diagnosing, grading and special tests are all guidelines that a medical staff can use to help them determine when a player can safely return to competition.

We should never take mild head injuries lightly. Young athletes should be held out of competition until they have been evaluated and cleared for competition by their physician.