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Concussion

The most common head injury in sports is concussion. Athletes who sustain a prolonged loss of consciousness should be transported immediately to a hospital for further evaluation. Assessment of less severe injuries should include a thorough neurologic examination. The duration of symptoms and the presence or absence of posttraumatic amnesia and loss of consciousness should be noted. To avoid premature return to play, a good understanding of the possible hazards is important. Potential hazards of premature return to play include the possibility of death from second-impact syndrome, permanent neurologic impairment from cumulative trauma, and the postconcussion syndrome.

Contact sports, especially football, hockey, and boxing, are leading causes of concussion. Other significant causes are falls, collisions, or injuries due to bicycling, horseback riding, skiing, and soccer.

The risk of concussion from football is extremely high, especially at the high school level. Research shows that about 1 in 5 high school football players suffer concussion or more serious brain injury at some point during their high school football career. The comparable rate at the college level is 1 in 20.

Concussion and lasting brain damage is also very common among boxers. After all, the goal of this sport is to knock out an opponent, that is, to give him or her a concussion. For this reason, the American Academy of Neurology (a group of doctors who specialize in problems of the nervous system) has called for a ban on boxing.

Treatment

The symptoms of concussion usually clear up quickly and without lasting effects. Medical specialists decide how soon a person can return to sports activities based on the severity of his or her injury. All treatment plans are designed to prevent a second blow to the head during recovery. A second blow may cause very serious long-term brain damage.

A Grade 1 concussion is usually treated with rest and continued observation only. The person can return to sports activities the same day if a medical professional approves and all symptoms are gone. If a second concussion occurs on the same day, the person should not be allowed to continue contact sports until he or she is free of symptoms for 1 week.

A person with a Grade 2 concussion must discontinue sports activities for the day. He or she must be observed by a medical professional and be observed throughout the day until all symptoms have disappeared. If symptoms become worse or continue beyond a week, further brain tests, such as a CAT scan, may be necessary. The person cannot return to contact sports until one week after symptoms have disappeared and a medical professional has given permission.

A person with a Grade 3 concussion should be seen immediately by a medical professional. If symptoms are severe, brain tests and hospitalization may be necessary. Prolonged unconsciousness and worsening symptoms require immediate examination by a neurologist. A neurologist is a doctor who specializes in problems of the nervous system. The patient should be carefully observed after discharge from medical care. If symptoms reappear or become worse, further neurological tests may be necessary.

A person with a Grade 3 concussion should avoid contact sports for at least a month after all symptoms have disappeared. If brain tests indicate that brain swelling or bleeding has occurred, the athlete should give up contact sports for the season and, if symptoms are bad enough, indefinitely.