Chris Maeda, MD

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Concussions: What We Need to Know to Protect Kids and Adults Alike

Now that football season is in full swing, the conversation about head injuries and sports is on many people’s minds. While football gets a lot of attention for concussions, the truth is concussions can occur in any sport or physical activity and may be more common than we think. Awareness of this injury is the key to keeping our athletes safe and avoiding potentially devastating outcomes.

First, it is important to know what exactly a concussion is and how someone gets a concussion. A concussion is a type of traumatic brain injury. Generally, concussions are caused by a direct blow to the head, face or neck. However, a concussion can also occur if the force or blow makes contact elsewhere on the body and results in a transmitted force to the head. (So, being knocked hard to the ground on the hip or taking a soccer ball in the back can cause trauma in the head.) In both scenarios—a direct or indirect impact—the force causes the brain to move in the skull, causing bruising of the brain. The bruising is what we call a concussion.

Second, athletes, coaches and parents should know the signs and symptoms of a concussion. Common symptoms include headache, feeling like your mind is in a fog, being more emotional than usual, behavioral changes, amnesia, loss of consciousness, slowed reaction times and trouble sleeping. Usually, concussion symptoms occur right away and cause short-lived (minutes to hours in duration) neurological impairment. However, symptoms or cognitive deficits may not appear until several hours following a concussive injury. Therefore, if a concussion is suspected, the person should be monitored for a few hours following the impact.

Third, in order to prevent further injury, it is extremely important to know what to do if you suspect someone is concussed. If you suspect a concussion, the person should not be allowed to return to the game or activity on the day of injury. A subsequent blow to a recently concussed player can cause the brain to swell and lead to brain damage or even death.

In 2009, Washington state passed a bill often referred to as the Lystedt Law. The law is named for Zackery Lystedt, a young athlete who in 2006 suffered a catastrophic brain injury after sustaining a concussion in the first half of a junior high football game. Lystedt returned to the field of play in the second half but then collapsed and was rushed to Harborview Medical Center. Incredibly, Lystedt survived the ordeal but spent three months in a coma and years afterward recovering his ability to speak, stand and get around on his own. The Lystedt Law states that any youth athlete suspected of having a concussion needs to be removed from play—“when in doubt, sit them out.” The law prompted 40 other states and the District of Columbia to pass similar laws.

All concussed individuals should be seen and evaluated by a physician or other licensed health-care provider to help confirm the diagnosis and provide guidance for treatment. A concussion is diagnosed based on the signs and symptoms a person may have; there is no imaging or blood test that will diagnose a concussion. MRI or CT scans usually are not obtained unless the provider is trying to rule out other possible injuries like a skull fracture.

The majority of concussions resolve in 7-10 days. However, in children and adolescents, the recovery can be around 10-14 days or even longer. The mainstay of treatment of concussion is rest, both physical and mental. Concussions are brain injuries; therefore, rest is essential for healing. Patients should avoid physical activities and limit mental stimulation, which means staying home from school or work and avoiding TV or video games. A gradual return to work, school, social and/or physical activities should be instituted in a manner that does not exacerbate symptoms. There are no medications or other treatments available to speed up recovery. People will recover from concussions over time, but having multiple concussions may increase one’s risk of potential brain impairments later on in life.

There are many ongoing studies to try to find ways to prevent concussions. The methods that have been shown to help lower the risk of concussions have been rule changes in sports and teaching proper technique, for instance proper tackling technique in football. Protective sports equipment like mouth guards and helmets can protect against other injuries, but they do not prevent concussions. It’s important for all athletes, youth, professional and recreational athletes alike, to understand that there is no piece of equipment currently available that has been proven to reduce the risk of concussion.

Concussions are all too common in sports, but knowing the signs, symptoms and treatment can help prevent further injury. In addition, better awareness of concussions can help us make sports safer for our athletes.

Dr. Chris Maeda has been named one of Seattle's best doctors for seven years in a row; he specializes in Sports Medicine. Click here to learn more about Dr. Maeda.