ACSM'S Health & Fitness Journal:
DEPARTMENTS: Fitness Focus
This copy-and-share column discusses concussion in youth sports
Brad A. Roy, Ph.D., FACSM, FACHE, is an administrator/executive director at Kalispell Regional Medical Center. He is responsible for The Summit Medical Fitness Center, a 114,800 sq ft medical fitness center located in Kalispell, Montana, and a number of other hospital departments. He is the editor of the Medical Fitness Association’s Standards and Guidelines for Medical Fitness Center Facilities and a past board chairman for the Medical Fitness Association.
Our knowledge about concussion has advanced significantly since the 1960s, and today, head trauma in youth sports is a hot topic across the nation. It is estimated that 3.8 million recreation and sport-related concussions occur in the United States each year. Although concussions represent nearly 9% of all high school athletic injuries, data are lacking for elementary and middle school sport participants. Current reports have identified higher concussion rates in girls than in boys participating in similar sports possibly because of a smaller head mass and weaker neck muscles than their male counterparts. This difference also could be related to underreporting by boys not wanting to be removed from competition.
The term “concussion” is derived from the Latin word concutere or “to shake violently.” This is exactly what a concussion is, a shaking of the brain inside the skull that impacts the alertness and brain function of the injured person.
There is a misconception that a concussion only occurs as a result of a direct blow to the head and typically results in loss of consciousness. Although a direct head blow frequently results in the most brain trauma, concussions can and frequently do occur without any direct head contact. A player who receives a jolt that causes his or her shoulders and head to change speed and/or direction rapidly can suffer a concussion. This is because the brain sits suspended within the skull, and such impacts can cause the brain to move within and make contact with the hard-surfaced bone material of the skull. Thus, concussions are caused by two types of forces: 1) linear, or straight-on force, and 2) rotational, or off-center impacts that cause the brain to rotate or spin within the skull.
Although additional research certainly is warranted and needed, a few facts from the U.S. Centers for Disease Control and Prevention regarding concussions should be remembered:
○ A concussion is a brain injury.
○ All concussions are serious.
○ Concussions can occur without loss of consciousness.
○ Concussions can occur in any sport both helmeted and nonhelmeted.
○ Recognition and proper management of concussions when they first occur can help prevent further injury or even death.
Headache is the most common symptom of concussion, although symptoms are varied widely and can mimic symptoms of other illnesses. Concussion signs and symptoms fall into the four categories presented in the Table.
Although the signs and symptoms of a concussion may present immediately after the injury, they initially also can appear days or weeks after the event. Once a concussion is recognized, it is critical that medical attention be sought right away. Early recognition and individualized treatment are important toward maximizing recovery and appropriate return to play.
Although some athletes require extended recovery times, most people with concussions recover in 7 to 14 days. Physical and mental rest is the primary treatment, and youth athletes should not be allowed to return to play on the same day that the injury occurs. Each athlete should be evaluated by a medical professional and a custom return-to-school and play plan developed. This plan generally is implemented once symptoms cease. Repeat concussion, occurring before the brain is recovered fully, can result in severe abnormalities and even death.
Sport-related concussions are common and, therefore, parents, coaches, teachers, and students should be familiar with concussion signs and symptoms. Although the majority of concussions are mild in nature, inadequate recovery places young athletes at risk for a subsequent and more severe injury, possible lifelong deficits and even death. Thus, early recognition and intervention are critical to maximizing recovery and favorable outcomes.