1. Concussions in Sport
Mitigating Risks in the Student Athlete

2. High School Concussions
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Over 50% of concussed high school football
athletes do NOT report their injury to medical
personnel
McCrea, M., Hammeke, T., Olsen, G., Leo, P., and Guskiewicz, K.M.
(2004). Unreported concussion in high school football players:
implications for prevention. Clin. J. Sport Med. 14, 13–17.

3. Collegiate Concussions
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Soccer, lacrosse, basketball, softball, baseball, and gymnastics
14,591 injuries in male and female athletes
5.9% of all injuries were classified as concussions
Males Game Injury Rate / 1000 exposures
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Soccer
Lacrosse
Basketball
1.40
1.46
0.47
Females
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Soccer
Lacrosse
Basketball
2.10
1.05
0.73

4. Perceptions
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Survey 300 players, 100 coaches, 100 parents, 100 ATCs
If a player complains of a headache , should return to play?
 Players 55%, Coaches 33%, ATC 30%, Parents 24%
Percentage who would play a concussed star in a title game?
 Players 54%, ATC 9%, Parents 6.1%, Coaches 2.1%
Level of concern for concussions (1 = most concerned; 4 = least)
 Players 3.5, Coaches 2.4, Parents 2.1, ATC 1.6
Is a good chance of playing in the NFL worth a decent chance of
permanent brain damage?
 Players 44.7%, Coaches 19.4%, Parents 15%, ATC 10%

5. Classification of concussions
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A concussion is a concussion
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There is no such thing as a mild concussion
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No grading system
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Most symptoms resolve in a short period of 7-10 days
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Post concussive symptoms may be prolonged in children

6. Symptoms
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Headache (83%)
Dizzy (65%), dazed, fog
Light and sound sensitivity
Visual disturbances
“Everything seems slow”
“My colors changed”
Teammate, “Eric’s not right, coach”
Appearance can be delayed several hours

7. Physical Signs
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You do not have to lose consciousness
Amnesia (“Doc, I don’t remember the first half”)
Emotional labile (crying, talkative)
Poor balance
Difficulty concentrating
Difficulty remembering

8. On-Field Evaluation
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Standard emergency management
Exclude cervical spine injury
Return to play determined by a physician
“When in doubt, sit them out”
No player shall return to play the same day
Sideline assessment of concussion (SCAT2)
Monitor for any deterioration over time

9. Concussion Management
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Complete physical and cognitive rest until symptom free
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No sports
No horseplay
No school, if necessary
No texting, video games, internet, TV, driving
Graded program of exertion prior to full return to play

10. Exertion effects
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Symptoms are worsened by
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physical activity
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mental effort
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environmental stimulation
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emotional stress

11. Post-concussion syndrome
Risk factors for complicated recovery
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Re-injury before complete recovery
Over-exertion early after injury
Significant stress
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Unable to participate in sports
Medical uncertainty
Academic difficulties
Prior or comorbid condition
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Migraine
Anxiety
ADHD, LD

12. Multiple Concussions
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Second Impact Syndrome
 A concussion prior to recovery from a prior concussion
 Athlete is still symptomatic
 Mostly males < 21 years old
 Rapid increase in intracranial pressure
 Rare but almost always fatal
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Cumulative effects
 Risk of concussion is 4-6 times greater after one concussion
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Risk is 8 times greater after sustaining two concussions
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Prolonged or incomplete recovery
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Increased risk of later depression or dementia
How many is too many ?

13. Graduated return to play protocol
Day 1
Day 2
Day 3
Day 4
Day 5
Light aerobic exercise
Light jog/stroll, stationary bicycle
Goal: elevate HR
Sport-specific exercise
Running drills in basketball
Goal: add movement
Non-contact training drills
Passing and shooting, light resistance training
Goal: coordination, cognitive load, valsava
Full contact practice only after physician clearance
Return to competition
Any symptoms at any stage, return to complete rest

14. Mechanism of Injury Hockey
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Body checking
86% of all injuries in 9 – 15 year old
Contact leagues
4x injury rate, 12x fracture rate
45% legal body checks, 8% illegal body checks
Direct fatality and injury rates for football are half of hockey
Spinal cord injury and brain injury rate
 2.6 per 100,000 high school hockey players
 .7 per 100,000 high school football players

15. Helmets and Mouth Guards
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Helmets prevent skull fractures
Helmets do not prevent concussions, they cause
concussions
Mouth guards prevent dental injuries
Mouth guards do not prevent concussions