1. UNIT II: CARE, PREVENTION AND REHABILITATION OF ATHLETIC INJURIES
Sports Medicine 15
UNIT II: CARE, PREVENTION AND REHABILITATION OF ATHLETIC INJURIES
CONCUSSIONS

2. Definitions
A concussion is defined as a “traumatically induced alteration in mental status.”
Amnesia - loss of memory - times vary.

3. The Head The head is not as forgiving as an arm, leg etc.
The brain does not like changes in blood flow or pH levels.
The brain has a different blood flow than the rest of the body.

4. Concussions This is the most common “brain” injury in sport.
Ranges from a minor “ding” with short periods of symptoms, to a prolonged loss of consciousness with persistent cognitive effects.

5. Concussions Memory Loss
Can be associated with amnesia which may occur immediately or develop several minutes later.
There are two kinds of amnesia:

6. Concussions
1. Retrograde Amnesia - loss of memory for events that occurred before injury (breakfast, score, team playing, etc).

7. Concussions
2. Anterograde Amnesia - is defined as a loss of memory for events that occurred after the injury.

8. Concussions - Problem???
With this possibility of “delayed development of symptoms”…
This greatly increases the need for careful evaluation and observation before the athlete is allowed to play.

9. Concussions Causes of Concussions: Direct blow to the head
Landing on your butt!!
Whiplash mechanism.

10. Concussions Contracoup Injury
This is a type of movement of the brain inside the skull…
When you get hit in the front of the head, the brain shifts (backwards) and pain will be felt at the back of the head (opposite side of injury).

11. Concussions Observed Features of Concussions: Headache Vacant stare
Confusion
Tinitis (ringing in ears)
Nausea/vomitting
Blurred vision
Dizziness

12. Concussions Other more serious symptoms: Altered Consciousness
Memory deficits
Lack of coordination/balance
Disorientation
Emotions
Pupil size***Eyes are poor indicator of concussion on sport field

13. Classification of Concussions:
GRADE 3
Any loss of consciousness, it can be brief (seconds) or prolonged (minutes).
GRADE 1
Transient confusion
(inattention inability to maintain a coherent stream of thought and carry out goal directed movements.
No loss of consciousness
GRADE 2
Transient confusion
Amnesia possible
No loss of consciousness
Concussion symptoms or mental status abnormalities (including amnesia) upon examination last more than 15 min.
Concussion symptoms or mental status abnormalities resolve in less than 15 min.

14. Concussions Management Recommendations: Grade 1 Concussion:
Remove from contest
Player should be re-evaluated every 5 minutes for at least 15 minutes for signs of amnesia and other mental status changes.

15. Concussions Management Recommendations: Grade 2 Concussion
With grade 2 injury, the athlete should be removed from play for the remainder of event (day).
Continue to assess any inter-crainial* pathology.
*inter-crainial - inside the head (brain).

16. Concussions Grade 2 cont.d
A trained person should evaluate the person next day.
A physician should perform a neurologic examination to clear the athlete after 1 full asymptomatic week.

17. Concussion Management Recommendations: Grade 3 Concussion
As with any loss of consciousness, the athlete should be transferred to an Emergency Department (hospital) for further observation by a doctor.

18. Concussions Grade 3 cont.d
A thorough neurologic assessment is indicated. (CT scan, MRI)
Keep casualty in the hospital if any pathology is indicated

19. Return to play Grade of Concussion Return to play only after
asymptomatic time.
15 minutes or less
Grade 1
Multiple grade 1
1 week
Grade 2
1 week
2 weeks
Multiple grade 2
Grade 3, brief LOC
1 week
2 weeks
Grade 3 prolonged LOC
1 month or longer, based on decision of evaluating physician, usually season terminator
Multiple grade 3

20. Concussions Sideline Evaluation
These are some of the tests that you can do with an
athlete on the sidelines (grade 1) or later on (grade
2,3):
Mental Status Testing
Orientation – to time, place, injury
Concentration – digits backward, numbers etc.
Memory – details of contest, names of teams, recall 3 of 3 words, objects at 5 min. intervals

21. Concussion Exertional Tests Neurologic tests 40 m sprint Strength
Sideline Evaluation cont.d
Exertional Tests
40 m sprint
5 push ups
5 sit ups
5 burpies
Neurologic tests
Strength
Coordination
Sensations
Balance
Check associated symptoms – headaches, dizziness, blurred vision, nausea, concentration, photophobia (sunlight)

22. Concussions Second Impact Syndrome
This condition occurs when the athlete returns to play to fast.
Another concussion is suffered before the symptoms of the first are resolved.
Loss of conciousness is not required.

23. Concussions
SIS
The hit does not need to be as hard or traumatic as the first.
After suffering a second hit, the player may seem fine, but within seconds or minutes SIS may occur.

24. Concussions
SIS
Previously observed features, but after SIS we may be looking at an extremely debilitating or life a threatening head injury.

25. Concussions Post Concussion Syndrome
Apart from SIS, this is another syndrome we need to be aware of.
As each person is different, the brain will react different to a concussion differently

26. Concussions
PCS
The following may occasionally persist after concussions:
Gait and Balance abnormality
Exertional headache:
When they do any physical activity they get a headache

27. Concussions PCS Emotional Lability Sleep disturbances
Altered emotions, crying/agitation
Sleep disturbances
Neurotransmitters in the brain are not functioning correctly
Cognitive impairment
Reflexes, coordiation

28. Concussions
PCS
Athletes with these symptoms are not ready to return to sport.
See next slide for return to play for these athletes:

29. Concussions Return to Play – Post Concussion
Step 1 – no activity, complete rest, once asymptomatic proceed to step 2
Step 2 – Light aerobic exercise (walking, stationary biking) if asymptomatic proceed to step three, if not go back to 1
Step 3 – Sport specific training. Once asymptomatic proceed to step four, if not go back to 2

30. Concussions Return to play – Post concussion
Step 4 – Non-contact drills, once asymptomatic proceed to step five, if not go back to 3
Step 5 – Full contact after medical clearance. Once asymptomatic proceed to step six, if not go back to 4
Step 6 – GAME PLAY!!!

31. Concussions Some Sports attempting to decrease Concussions.
2. Football:
Equipment:
Mandatory mouthguards
Helmets safety checked each season
Padding on all goal posts.

32. Concussions Football Cont. Rule Changes
No spearing (tackling with head)
No face masking
No late hits
Free catch
Rules to protect quarterback and kicker

33. Concussions 2. Hockey Equipment Mandatory helmets
Mouthgaurds – highly recommended
Breakaway goal posts
Padding around benches, glass
Absorbing boards

34. Concussions Hockey cont.d No hitting from behind
Rules to deter fighting
No high sticking
Goalie protection
Longer suspensions

35. Concussions 3. Rugby Equipment: not too much here!!!
Mandatory mouth guards
Scrum caps are recommended
Padding around goal posts
No hard equipment

36. Concussions Rugby cont.d Rules: No high tackles No late hits
No stomping
Mark catches
No blocking
Wrap person when tackling