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Sunday, October 4, 2009

Concussions: What Are The Symptoms And When Should Athletes Return to Play:

Fall sports are in full swing and unfortunately so are on the field injuries. One of the more concerning injuries is a concussion. Every year it is estimated that 300,000 young athletes suffer from concussive episodes. Although concussions are more common in high impact sports, any blow or jolt to the head during practices or games can result in a concussion. Parents of athletes both young and old should be familiar with the signs and symptoms of a concussion as well as the guidelines for when it is safe to return to play.

Concussions, no matter how mild, are always something to take seriously. They are a traumatic brain injury. They can range in severity but even a mild concussion can have consequences especially if an athlete sustains a second injury before he or she has fully recovered from the first. Second Impact Syndrome, as it is aptly called, occurs when an athlete incurs a second concussion while still having concussive or post-concussive symptoms. As surprising as it may sound Second Impact Syndrome is associated with a mortality rate of 70-80%. It is therefore imperative that young athletes are appropriately screened for continued symptoms and do not return to play until they have fully recovered.

Symptoms of a concussion can occur immediately after the injury or weeks later. Symptoms can range from confusion after the play to feeling sluggish, moody or having trouble concentrating many days or weeks later. The Center for Disease Control has a wonderful toolkit to help parents, coaches and athletes identify the symptoms of a concussion.

Any child or adolescent who incurs a concussive injury should be evaluated by a doctor. The majority of concussions are mild and resolve in 7-10 days. Once symptoms have resolved, a return to activity should be attempted in a stepwise fashion. According to the American Academy of Pediatrics, children should be monitored while attempting each of the following steps. If concussive symptoms recur with an increase in activity, the activity should be discontinued and the athlete should return to complete rest for 24 to 48 hours before attempting the steps again.

1. Complete rest - okay to continue with school but no increased activity.
2. Light (low-intensity) aerobic exercise, such as walking, without a component of resistance. Weightlifting is prohibited.
3. Activity specific to the sport, such as running or skating. Resistance training okay.
4. Training drills without contact, followed by mental status testing. Resistance training okay.
5. Full-contact training after clearance by medical personnel.
6. Participation in a game.

If concussive symptoms persist or return, the athlete may be experiencing Post-concussive Syndrome. It is important for parents, teachers and coaches to be on the lookout for any change in mood, irritability or difficulty concentrating, as these may be subtle symptoms of Post-concussive Syndrome. An athlete experiencing Post-concussive Syndrome should not return to play and should be evaluated by a physician.

Lastly, having had a concussion in the past increases an athlete's risk by six fold that he or she will sustain a concussion in the future. Thus, it is extremely important that athletes inform their coaches not only of new injuries but also of any concussions they have experienced in the past.