It is clear with current research that concussions need to be taken seriously and should be evaluated by a physician with specific expertise in this area. The goal is accurate assessment, proper management, and return to play as soon as safely possible. Concussed athletes are required to see a physician (MD or DO) before they are released back into play. There is also value in doing baseline testing for concussions before the season begins.
San Diego Sports Medicine & Family Health Center (SDSM) has been a leader in the evaluation and treatment of sport-related concussions since the 1980s. Our team of sports medicine physicians has worked with athletes of all levels from professional to Pop Warner, including: Olympic athletes, US National Teams, San Diego Chargers, San Diego State University, several local colleges, a large number of San Diego high schools, as well as numerous other athletic events. Our concussion policy and concussion management protocol has been developed after years of hands-on experience and dedication to the field of sports medicine, and from the most recent literature on sport-related concussion.
DEFINITION OF CONCUSSION
A concussion is a relatively mild injury of the brain. There is no structural change of the brain or bleeding that shows up on scans or X-rays. A concussion can happen from either trauma or rapid motion of the head.
CONCERNS WITH HEAD INJURIES
With any injury to the head, it is important to rule out more severe injuries, such as fractures or intracranial bleeds, which may not present for up to 24 hours after the injury. These bleeds typically cause a progressive loss in neurologic function and can be life-threatening. Keen evaluation is required to know when the athlete needs to have a brain scan to pick up these very dangerous intracranial bleeds.
Concussions are usually not as severe as the injuries described above and typically resolve within 1 to 6 weeks. However, a small percentage of these head injuries can result in more serious problems, listed below:
- Post-concussion syndrome: The same symptoms of a concussion which last for weeks, months, or even years after the initial injury.
- Second impact syndrome: A condition where an athlete sustains another head injury before the concussion has resolved. This syndrome is very serious and can lead to rapid coma and even death.
- Chronic Traumatic Encephalopathy: Chronic symptoms from repeated head injuries.
Common symptoms that may appear are headache, dizziness, a cloudy or dazed feeling, loss of memory, irritability, nausea, sensitivity to light or sounds, and drowsiness. Although loss of consciousness may occur, an injury that does not cause loss of consciousness still may cause a concussion.
Concussions do not show up on MRIs, CAT scans, or EEGs. They are diagnosed by a medical professional evaluating brain functions such as memory and the ability to think clearly and calculate, as well as evaluating balance and visual function.
Because the brain is so complex and the injuries are so varied, there is a wide diversity of manifestations of head injuries. Our physicians depend on their wealth of experience in addition to utilizing sophisticated equipment to properly diagnose and manage concussions. Getting a clear picture of the mechanism of injury, watching the athlete’s behavior, and performing a thorough exam are keys to proper care. SDSM also utilizes ImPact, a computerized assessment of brain function and reaction time. We also use balance assessments and visual exams to further define our diagnosis.
After accurate diagnosis, head injury management is focused on proper recovery as well as preventing further injury:
- Preventing further injury: Physical and mental rest. The athlete must reduce any risk of another injury to the head so physical activity and risk of head injury is significantly reduced. It is also important to reduce the mental activity of the brain. Taking a test, going to concerts, or playing video games can overburden the brain and reduce recovery. Like an injury to any part of the body, the brain needs rest after the injury to heal appropriately. We also recommend obtaining baseline information of the athlete before the season using computerized testing and balance boards to hold, and compare to information after the concussion to see when they have recovered.
- Recovery: When the injured athlete’s symptoms are significantly improved, we begin a progressive increase in physical as well as mental activity. Our medical team works with the athlete’s school, organization, and support group to gradually increase their participation as tolerated.
Proper management of concussion is a changing art over the last several years. Guidelines and protocols are important, but the current mainstay of care is to individualized treatment. Our program is under the direct supervision of our physicians and is tailored to each injured athlete.
Research has shown even mild head injuries can have more severe long-term effects. Along with nationwide suboptimal management, this has led to legislation of accepted guidelines for care. In January 2015, California passed and implemented AB 2127, which applies to all high school athletes. Below is an excerpt:
An athlete who is suspected of sustaining a concussion or head injury in an athletic activity shall be immediately removed from the athletic activity for the remainder of the day, and shall not be permitted to return to the athletic activity until he or she is evaluated by a licensed health care provider. The athlete shall not be permitted to return to the athletic activity until he or she receives written clearance to return to the athletic activity from a licensed health care provider. If the licensed health care provider determines that the athlete sustained a concussion or a head injury, the athlete shall also complete a graduated return-to-play protocol of no less than seven days in duration under the supervision of a licensed health care provider.
SDSM has over 30 years of managing injured athletes, and our physicians are leaders in setting up injury management protocols. Our goal is to effectively return the athlete to play as soon as safely possible while mitigating the risk of long-term problems.
If you or your child has experienced a head injury and would like expert diagnosis and treatment, please call us today for an appointment!
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