What is a concussion?
A concussion is a mild brain injury. You do not need to lose consciousness to have a concussion.

What are the signs and symptoms?

Thinking Symptoms

• Poor attention/concentration
• Problems remembering
• Difficulty following conversation
• Answers questions slowly
• Asks same question repeatedly
• Mentally foggy

Physical Symptoms

• Headaches
• Vacant stare
• Appears dazed or stunned
• Dizziness
• Clumsiness/balance problems
• Fuzzy/blurry vision
  
• Sleeps more or less than usual
  
• Appears fatigued, tired or sleepy
  
• Vomiting/nausea

• Nervousness/anxiety
• Sadness
• Irritability
• Personality changes
• Plays less

Athletes themselves are not necessarily the most reliable reporters of symptoms. It is important to get their input, but also to be observant of symptoms that may not be evident to the athlete or not reported by them.

How common is the problem?

• In sports alone, there are over 300,000 concussions per year.
• More than one million children sustain a mild brain trauma/concussion each year.
• For every one concussion in the NFL, there are 5,690 youth brain injuries.

What are the risks of prematurely returning to play?

• Increased vulnerability to re-injury: the first seven – ten days are critical.
• Initial studies show an average recovery length of seven days.
• 75% of repeat concussions occur within the first seven days.
• 92% of repeat concussions occur within the first ten days.
• Cumulative effects: three or more concussions result in a poorer outcome and lowered level of threshold for re-injury.
• Second Impact Syndrome: A second brain injury to the brain before the brain heals from prior injury. This occurs almost exclusively in teens. It is rare, but may be serious and even fatal as a result of rapid brain swelling.
  

How do I assess on the field? When is it safe to return?
Ask yourself, “Do I have the expertise to do this assessment?” If not, consult your physician and/or experts in the area. (Example: Children’s National Medical Center: 202.884.2429)

Do not return to play if there are any observed or reported symptoms both at rest and when exerted.

What should I do if I’m not sure?
Do not return the athlete to play if you suspect or observe any evidence of concussion.

Does age matter?
A common misconception is that kids recover more quickly because they are young and can “bounce back” more quickly. New studies suggest that younger athletes (high school age, teens) may be more vulnerable to the effects of concussion and slower to recover than collegiate athletes.

How does an athlete return to play?
Initially:
1. Sleep/low activity–not increasing heart rate significantly
2. Involve coach, sports medicine physician, neuropsychologist, athletic trainer, parent, and athlete in team planning.

Typical progression:
The following is a typical progression. Seek medical guidance for individual planning.
1. Ride stationary bike, avoid jarring activity, eventual/gradual return to running
2. Sports-specific, non-contact training
3. Running plays, non-contact
4. Full contact with controlled practice
5. Game
What can I do to reduce the risk of serious injury?

• Spread the word–a “ding” or getting your “bell rung” means you’ve had a brain injury.
• Encourage athletes and their friends to report injuries and symptoms.
• Take charge and put athletes safety first to prevent potentially more serious injury.
• Educate coaches, players, families, and others to encourage reporting and increasing awareness.

Important But Little Known Facts:

• Loss of consciousness occurs only in a small percentage of individuals who sustain a concussion.
• Premature exertion can prolong recovery and worsen the outcome.
• Football injuries associated with the brain occur at a rate of one every three games.
• The head is involved in more baseball injuries than any other part of the body.
• Headaches indicate incomplete recovery.
• Amnesia may be a better predictor of severity of injury than loss of consciousness.
• Children and teens may be more vulnerable than collegiate or adult athletes.

If an injury occurs, please report to the nearest urgent care facility or emergency department.  For more information, please call 301-790-8025.