Monday Medical: The concussion conundrum, Part I
December 7, 2009
Signs of concussion
■ Appears to be dazed or stunned
■ Loses consciousness (even temporarily)
■ Confused about assignment
■ Forgets events before hit, after hit
■ Forgets plays
■ Unsure of game, score or opponent
■ Moves clumsily
■ Answers questions slowly
■ Shows behavior or personality change
Symptoms of concussion
■ Balance problems
■ Neck pain
■ Sensitivity to light or noise
■ Feeling more emotional
■ Feeling mentally “foggy”
■ Vision problems
■ Numbness or tingling
■ Feeling sluggish
■ Difficulty concentrating or remembering
In my life, I wear four hats: husband, dad, physical therapist and football coach. During this past football season, I struggled with sorting out what was the most appropriate hat to wear.
My son, a sophomore on the Steamboat Springs High School football team, had a concussion in August. Because of the severity of the concussion and the fact that this was not his first, we began what has turned into a four-month process of talking to multiple physicians and specialists.
As my son has gone through numerous tests and exams, I have been researching and reading everything I could find on the topic of concussions. My hope in writing this is to bring some awareness to the concussion conundrum and how this experience has affected me in the various roles I live and the different hats I wear.
First of all, for the athlete who "gets their bell rung," you need to know that this is not normal. Working through a concussion has nothing to do with how tough you are. You should never "play through it." It is not "just a headache." You must be honest when you are hurt and tell your coach.
The severity of symptoms in concussions varies greatly, and we as coaches do not always see everything and certainly do not know how you are feeling.
As coaches we must understand that athletes who "get their bell rung" need appropriate attention. There is no such thing as a "minor" concussion, no matter how small the impact or how minor the symptoms.
The athlete should be removed from play and examined by qualified personnel. If in doubt, take the player out. You would not return a player to the field with a torn ligament or muscle; take the same consideration with a head injury.
Continue to monitor your athletes as they return to normal play. There may be no symptoms of concussion during normal activities, but upon exertion, symptoms may reappear. Follow-up examinations should be done post-exercise, at return to practice and in post-game simulation drills.
For parents of athletes, if your child has a concussion, be aware of potential post-concussive complications. Specifically, be alert to depression.
It's difficult, I know. Teenagers already are moody, emotional and irritable and don't talk to us parents, but we must engage. Talk to your athlete; talk to his or her friends, teachers and coaches. It's the last thing they may want, but it's exactly what they need. They need help.
Finally, to the health care providers, we need a consistent team approach to advocate for the athlete. Concussions can be complex. No two concussions are the same, and the effects on the athlete vary greatly.
A complete medical evaluation should be automatic. Musculoskeletal issues may need to be addressed (neck pain often is associated with concussion), psychological issues may be present, modifications at school may need to be addressed, specialists may need to be consulted.
No hit or fall is too small to produce a concussion. It takes the right direction of force on the head to produce symptoms. Players showing any signs or symptoms of concussion should be monitored and preferably tested before returning to play.
Testing is available that can help you determine whether an athlete can return safely to contact play after a concussion. One such testing system is called the ImPACT (Immediate Post-Concussion and Cognitive Testing). ImPACT is the most widely used computerized concussion evaluation system and will be available at SportsMed at Yampa Valley Medical Center.
The second article in this series will run Dec. 14 and will discuss upcoming programs regarding this testing.
You can learn more about concussions and head injuries by attending the Dec. 14 "Taking Care of Me" educational presentation at 7 p.m. at Yampa Valley Medical Center. Michael Collins, Ph.D., assistant director of the University of Pittsburgh Medical Center Sports Medicine Concussion Program, has important information to share.
Lance Pugh, PT, is a physical therapist at Yampa Valley Medical Center's SportsMed. He treats patients in Hayden and Steamboat Springs and can be reached at firstname.lastname@example.org.