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By USA Baseball Medical/Safety Committee – (Reprinted with permission 4/1/2012)
Concussion injuries in all levels of sport have been a major topic in the press and medical literature over the past couple of years. According to the Centers for Disease Control and Prevention there may be as many as 3.8 million sports and recreation related concussions in the United States each year. Concussions account for one in ten of all sports injuries, and for young people ages 15-24 sports are second only to motor vehicle accidents as the leading cause of brain injury. (1) United States emergency departments treat an estimated 135,000 sports and recreation traumatic brain injuries (TBI), including concussions, each year in children ages 5 to 18. Concussions can happen in any sport and at any age.
What is a concussion? A concussion is a brain injury that can be caused by a blow or jolt to the head and can change the way the brain normally works. Any concussion is serious whether mild or severe. They can also be caused by a blow to the body that causes the head to move rapidly back and forth and causes the brain to strike the surrounding skull. Concussions most often do NOT result in loss of consciousness - only 10% involve loss of consciousness.
Some of the symptoms of concussion that may be reported by the athlete are as follows:
Sensitivity to Light
Sensitivity to Noise
Slowed Reaction Times
Loss of Balance
Coaches may observe the following in a concussed athlete:
Loss of Consciousness
Cannot Recall Events after Hit or Fall-
According to the Consensus Statement on Concussion in Sport by the 3rd International Conference on Concussion in Sport, an athlete showing any of the above signs of concussion should be medically evaluated onsite. If no health care provider is available, the player should be removed from play and referred immediately to a physician. Once the first aid issues are addressed, an assessment of the concussion can be made. The player should not be left alone following the injury because monitoring for deterioration is important. A player with a diagnosed or suspected concussion should not be allowed to return to play on the day of the injury. (2) Concussed athletes should not return to play until all signs and symptoms have resolved at rest, and then following exertion using a graduated protocol (see below). An athlete should never be released to participation without a signed statement from a medical physician.
There should be a graduated return-to-play protocol following a concussion, and the athlete can proceed to the next level if there are no symptoms at the present level. The graduated return-to-play protocol is as follows: (2) each step generally takes 24 hours. If there are any symptoms at any stage, the athlete should drop back to the previous stage.
No Activity -- Complete physical and cognitive rest
Light aerobic exercise -- Walking, stationary bike, no resistance training
Sport-specific exercise -- Running drills, etc. with no head impact activities
Non-contact drills -- Start progressive resistance training
Full contact practice -- Following medical clearance normal training activities
Return to play -- Normal game play
A repeat concussion before the brain fully heals can slow recovery and increase the possibility of long term problems. In some cases repeat concussions can result in permanent brain damage and death, which is called second impact syndrome. It is important for athletes, coaches, and parents to be aware of the signs and symptoms of concussion, how to prevent concussions, and to never to allow an athlete to return to play following a concussion without proper care- no matter how minor the injury might seem. Every organization should have a written injury management protocol, and everyone associated with the organization should have a copy - coaches, athletes, athletic trainers, physicians, and parents.
1. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Heads-Up Concussion in Youth Sports.
2. McCrory P and al: Consensus Statement on Concussion in Sport, 3rd International Conference on Concussion in Sport, Zurich, November 2008. Clinics in Sports Medicine, Volume 19, Number 3, May 2009.
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