Concussions and Your Little Athlete

As middle and high school students stream back onto athletic fields and courts, parents and coaches need to team up to prevent brain injuries in young athletes and to seek rapid and appropriate treatment in the event of a sports-related blow to the head.

The Centers for Disease Control and Prevention reports that U.S. emergency departments treat an estimated 135,000 sports- and recreation-related traumatic brain injuries (TBIs), including concussions, in children ages 5 to 18 every year. A concussion is a type of traumatic brain injury resulting from a bump, blow, or jolt to the head. All concussions are serious, and must be treated right away to prevent further injury or in extreme and rare cases, death.

The image of a brain-jarring tackle in football may come to mind first when hearing the word concussion. However, this type of brain injury can occur in any sport, and girls are at risk, too. A lacrosse ball, volleyball, or softball hurtling toward the head, or falls from complicated cheerleading mounts or gymnastics routines also pose head injury danger.  

These injuries don’t always occur during active play. “Concussions occur during practice, too,” said John Hajaliloo, M.D., a Long Beach orthopedic surgeon who specializes in treating teenagers with sports injuries. “The kids are out there giving 150 percent in practice because they want to play, and that’s when concussions can happen,” he said.
Hajaliloo also pointed out that any force or blow to the body strong enough to move the head suddenly and severely can result in a concussion—the impact does not have to be directly to the head.

Preventing concussions begins with proper equipment, a thorough review of safe playing practices among coaches, parents, and athletes, and a clear understanding of how to recognize a concussion and what to do if this type of injury occurs.

Signs of a concussion include headache, dizziness, irritability, mood changes, vomiting, changes in vision and hearing, and difficulty following instructions.  An athlete may report “not feeling right” after a concussion. These symptoms can occur hours or days after the injury.

Most concussions occur without loss of consciousness, said Marcos Di Pinto, Ph.D., a pediatric neuropsychologist at Children’s Hospital of Orange County (CHOC). Even if an athlete claims, “I’m fine” or appears to be OK after sustaining a blow to the head, it’s vital to be checked by a health care professional who is experienced in evaluating concussions.  Knowing the right questions to ask an athlete is very important, Di Pinto said.

An athlete who is asked what happened right before the injury may not recall, or may recall something from two or three minutes before the hit, but not immediately prior to it. “For example, an athlete might say the last thing he remembers is that the score was 30 to 10, but that may have actually been two minutes before the injury,” Di Pinto said. Not being able to recall what happened 30 seconds ago is another red flag, he added.   

A computerized concussion evaluation system called Impact measures an athlete’s processing speed, reaction time, verbal and visual memory, and certain aspect of attention and concentration, Di Pinto said. Used by the NFL and NHL, Impact testing is available at CHOC and at some high schools in Orange County. The assessment can help determine when and if an athlete is ready to return to play. Impact test results are only part of the picture, Di Pinto noted, along with a thorough interview of the injured athlete and a review of symptoms.

It’s essential to remove the injured athlete from play any time a concussion is suspected, to give the brain adequate time to rest and recover, usually seven to 10 days. When an athlete is symptom-free, he or she can usually return to play, but this return must be done in a gradual, step-by-step fashion.  

For the first week after returning to play, the athlete may participate only in conditioning exercises, followed by the second week of live drills and gradual contact. By the third week, if the athlete has no further symptoms, he or she is usually cleared to play with full contact. If at any time during the gradual return any symptoms of the concussion recur, such as dizziness, the athlete should return to the previous step and continue there until no symptoms are present, according to Di Pinto.

Athletes who return to play too soon before a concussion has fully healed and who sustain another head injury are at risk for “second-impact syndrome.” With second-impact syndrome, the recurring brain injury produces very serious and potentially fatal complications, such as brain swelling or other brain damage. “Sudden-impact syndrome is rare,” Di Pinto said.

This rare syndrome may have contributed to the death of a 17-year-old high school athlete from Virginia who committed suicide after sustaining a head injury in football. Austin Trenum had no history of depression or emotional problems, but a postmortem study of his brain revealed damage to the parts of the brain that regulate impulsivity and judgment. Although experts can’t conclude that Austin’s suicide resulted from his last head injury, there is speculation that he may have suffered earlier, undetected concussions, and that his final injury produced severe changes in brain function and reasoning associated with second-impact syndrome.

“Athletes under 18 take longer to recover from concussions than adults,” said John Hajaliloo. “Just because symptoms disappear doesn’t mean an athlete can be sent back to play right away.”