What You Need to Know about Sports Concussions

By Denise A. McGinley, RN, MSNAd, Director, Center for Orthopaedic Innovation, St. Luke’s Medical Center, Tempe St. Luke’s Hospital

yourAZhealth_Concussions_finalWhile sports concussions have gained national attention over the past several years, many parents and young athletes remain unaware of or confused by the facts. Hopefully today’s blog will increase understanding of what the sports medicine community now knows about concussion.

Fact: 3.8 million concussions are seen in the ER every year … a number that has doubled since 2002. This is, in part, due to the growth of sports programs, but may also reflect an increased awareness of the dangers of concussion injuries.

Fact: 5-10% of all athletes will experience at least one concussion during their sports’ season.

Fact: Only 25-30% of concussions occur during practice; the vast majority occur during actual competitive play.

Fact: Less than 10% of all concussions involve a loss of consciousness. Many are simply reported as feeling temporarily ‘dazed’. For men, football poses the greatest risk of head injury (75%) with an average of 900-1500 blows to the head per season. This is followed by ice hockey and men’s lacrosse. For women, soccer accounts for the most injuries, followed by lacrosse and basketball.

Fact: Women are two times more likely than men to sustain a concussion, with more symptoms and a slower recovery rate. This may be, in part, due to the impact speeds at the point of contact. A boxers punch packs about 20 mph of impact speed, a standing tackle about 25 mph, and a soccer ball nearly 70 mph when headed. Since soccer participation is higher in females, it may explain the higher injury rate and increased severity.

Fact: Age matters. The brain is not fully mature until an athlete’s mid-twenties. Severe or repetitive injuries in youth may disrupt normal brain development, especially in the frontal lobe which is the most common location of concussive brain injury. The frontal lobe controls impulse and judgment as well as problem solving. The result may be risk taking behaviors that endanger the athlete. The frontal lobe also controls social initiation and response, making it difficult for the student to make or sustain friendships or other long lasting relationships. Finally, the frontal lobe controls emotions. Serious or repetitive head injuries may result in anxiety or severe depression. In fact, a recent study demonstrated a 3 times greater risk for suicide among athletes who sustained a concussion.

Concussion is not an innocent or ‘minor’ diagnosis, it is a brain injury and should be recognized as such by both the athlete, his/her coaches and trainers, teachers and parents. Here are some tips for concussion care:

DO get baseline concussion testing at the start of each sports season. This will help coaches and trainers evaluate subtle changes after an injury.

DO take a time out from play for a sideline evaluation after a blow to the head, even if the effects lasted only a few seconds.

DO return to play prudently … most often following a stepped program that monitors exacerbation of symptoms during periods of progressive aerobic and anaerobic exercise. Follow the recommended program, even if it takes you out of play.

DO monitor your child or student(s) after a concussive injury to watch for the telltale signs of more permanent and serious impairment, such as increasing isolation from friends, lack of interest in hobbies, deteriorating grades or ongoing complaints of headache or malaise. Symptoms may be subtle, and easily missed, and may take weeks to months to recognize.

DO seek the help of an expert if you or your child sustain a concussion, or experience symptoms that are slow to resolve.

References:
Marar, M; McIlvain NM; Fields SK; ComstockRD: Epidemiology of Concussions among US high School Athletes in 20 sports; Am J or Sports Medicine 2012, Apr 40 (4), pp 747-55
Centers for Disease Control, 2012 Report of US Injury Surveillance System
Fralik, M; Thiruchelvam, D et al: Risk of Suicide after a Concussion; Canadian Medical Association Journal 2016, Online Feb.