Knowing the signs of concussion will help you protect your players.

No single word has dominated football conversation this year as much as concussion. In Pop Warner, high school, college and the NFL, coaches, physicians and fans are more than ever focused on player safety and traumatic brain injuries. The medical research is worrisome. What has emerged as central to all football in 2012 is the importance of having a sideline medical authority responsible for evaluating players facing the possibility of a concussion.

The Medical Perspective

The Center for Disease Control is the U.S. public health agency responsible for everything that affects the health of the nation, including all types of injury and violence. Dr. Julie Gilchrist is a researcher on the Home and Research Injury Prevention Team that includes sports. 

A concussion is a fractural injury of the brain, not a structural one. According to Dr. Gilchrist, structural injuries are fractures or bleeds that show up in X-rays or MRIs. “A fractural injury is the way the brain chemically works and talks to itself and makes things happen and gets changed which is where symptoms come in,” she said. “This cascade of chemical changes happens over time. Many people have symptoms right away. They get up from the hit, may seem a little dazed and not altogether with it. Those you can diagnose pretty quickly. But in others the symptoms will evolve over time.”

More specifically with a concussion, two major symptoms emerge – headaches and memory problems – which get worse. “Over the next few hours and days they may not be themselves and things can get worse, “ said Dr. Gilchrist. “I wouldn’t necessarily call it a delayed concussion because the concussion did actually occur when the player was hit but it’s not unusual for the symptoms to occur over time. The way we like to manage concussions is to eliminate the things that can bring back symptoms. The symptoms are what delay  recovery. The symptoms tell you the brain is doing more than it can handle. So trying to minimize the symptoms means that the brain has more energy to try to heal.”

What puts players at risk are bumps, blows or jolts to the head or body that cause the brain to bang around inside the skull. Another risk factor is a history of past concussions. Once you’ve had one, your risk for future concussions goes up.

 “Each concussion is individual, meaning that even though someone has had a concussion in the past, it does not mean that a second concussion will necessarily behave like the last one did,” said Dr. Gilchrist. “They’re individual concussions for that person and also individual ones that could be different for someone else. Each one depends on where the forces were on the brain and what was going on at the time. Each management (treatment) depends on the individual’s symptoms. You must monitor the symptoms, figure out what is triggering them and minimize those triggers. Let the brain have the time to heal and recognize when it is safe for them to resume their activities.”

Among the findings in a CDC study of high school athletics was a greater incidence of concussions than reported a decade earlier. “The higher rate,” they reported, “may reflect an increased awareness of, and subsequent diagnosis and treatment of, concussions.”

The CDC has developed a valuable educational tool kit, “Heads Up: Concussions in High School Sports,” that is available to the public and coaches. “We believe our awareness program over the last few years” Gilchrist continued, “takes symptoms seriously, gets them evaluated, and managed.”

Dr. Gilchrist outlined some of the symptoms to be on the outlook for with our athletes. “We don’t want our sports injury numbers to scare parents away from having their kids participate in any activity. At the same time you have to recognize these risks.”

Dr. Gilchrist listed ten specific symptoms to look for:

1.    Headaches     6.    Having trouble staying asleep
2.    Memory loss         7.    Sleeping more than usual
3.    Feeling fuzzy           8.    Feeling anxious
4.    Moodiness         9.    Feeling nervous
5.    Having trouble falling asleep    10.    Showing signs of being upset 

Dr. Burak Ozgur is a double certified neurosurgeon who has treated many athletes. Dr. Ozgur identified more cautionary signs. “Sometimes when a boy has suffered a concussion there are obvious signs anyone can notice. They may look in a daze. Their eyes may not be looking straight at you. They may be speaking some sort of gibberish, or not making much sense. You can ask them basic questions like, ‘Who are you?’ ‘What day is it?’ ‘What year is it?’ ‘What direction are you going in?’

One of Dr. Ozgur’s former patients was the late Bubba Smith, a former All-American at Michigan State and NFL All-Pro. “He told me amazing stories of the many concussions he had among so many injuries,” said Dr Ozgur. “He had been through all of it and many times he didn’t even know which way to run. They would simply point him in one direction and say ‘go that way.’ It was a time when medicine was not there to protect our athletes. That’s what we want to avoid with our kids and with athletes at all levels.”

Dr. William Heinz is Chairman of the Sports Medicine Advisory Committee of the National Federation of High School Associations. According to Dr. Heinz, there is no such thing as a ‘ding’ or ‘bellringer.’ “We’re recognizing the signs better now. But the bottom line is there is no answer for concussions right now. We continue to look for one. There’s a real threat to the grassroots level of football. We’ve tried to do some things with the rules to try and make it better. Keeping your head up and seeing what you’re hitting is one of the things that seems to help.”

Youth Athletes at Risk

Dr. Heinz explained that additional scrutiny is needed at an even earlier stage. “The youth level of play is the worst age to have a brain injury,” Dr Heinz said. “They don’t recover as well. Unfortunately, we don’t have a litmus test to tell when somebody has been truly concussed. There are no athletic trainers (on the sidelines) at the Pop Warner and junior high levels of football.”

Dr. Gilchrist concurred that concussions can be the most traumatic for youth players. “Concussions require force. Young players are at risk. Young brains are at risk. Once your brain is mature you are at less risk. So we are more concerned with youth and middle school players as well as high school athletes because those boys still have developing brains.”

USA football and its partners, including the NFL, are committed to making sure youth football has the tools and resources needed to better protect all of the young players. “Education is the first step to help protect players from concussion,” said USA Football Executive Director Scott Hallenbeck. “Our Heads Up Program is intended to lead to a better and safer game. We have a national campaign in place to drive people back to our web site – www.usafootball.com/playersafety – and educate the parents, coaches, administrators and high school athletic directors about overall player safety and, more importantly, concussion awareness.”

USA Football also has a partnership with the CDC. “We both have ‘Heads Up’ programs,” said Hallenbeck. “We work very closely with them and our program dovetails with theirs. We all want to make football a safer game.”