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Concussions

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Jake banged his head hard when he was tackled, and he felt kind of weird afterward. He thought it was just another hit that he could shake off — and he wanted to stay on the field. After the game, though, he felt pretty sick. Should Jake have kept on playing?

Definitely not. Jake may have had a concussion, and it was actually a bad idea for him to stay in the game.

What Is a Concussion and What Causes It?

The brain is made of soft tissue and is cushioned by spinal fluid. It is encased in the hard, protective skull. When a person gets a head injury, the brain can slosh around inside the skull and even bang against it. This can lead to bruising of the brain, tearing of blood vessels, and injury to the nerves. When this happens, a person can get a concussion — a temporary loss of normal brain function.

Most people with concussions recover just fine with appropriate treatment. But it's important to take proper steps if you suspect a concussion because it can be serious.

Concussions and other brain injuries are fairly common. About every 21 seconds, someone in the United States has a serious brain injury. One of the most common reasons people get concussions is through a sports injury. High-contact sports such as football, boxing, and hockey pose a higher risk of head injury, even with the use of protective headgear.

People can also get concussions from falls, car accidents, bike and blading mishaps, and physical violence, such as fighting. Guys are more likely to get concussions than girls. However, in certain sports, like soccer, girls have a higher potential for concussion.

What Are the Signs and Symptoms?

The signs of concussion are not always well recognized. Because of that, people may put themselves at risk for serious injury by returning to a game before they should, getting back on a skateboard, or hitting the slopes thinking nothing's wrong. That's a problem, because if the brain hasn't healed properly from a concussion and someone gets another brain injury (even if it's with less force), it can be serious.

Repeated injury to the brain can lead to swelling, and sometimes people develop long-term disabilities, or even die, as a result of serious head injuries. So it's really important to recognize and understand the signals of a concussion.

Although we may think of a concussion as someone passing out, a person can have a concussion and never lose consciousness.

Symptoms of a concussion may include:

  • "seeing stars" and feeling dazed, dizzy, or lightheaded
  • memory loss, such as trouble remembering things that happened right before and after the injury
  • nausea or vomiting
  • headaches
  • blurred vision and sensitivity to light
  • slurred speech or saying things that don't make sense
  • difficulty concentrating, thinking, or making decisions
  • difficulty with coordination or balance (such as being unable to catch a ball or other easy tasks
  • feeling anxious or irritable for no apparent reason
  • feeling overly tired

Different Grades of Concussion

The two different types of concussion are:

  • Simple concussion. With a simple concussion, a person's symptoms get better over 7-10 days.
  • Complex concussion. With a complex concussion, symptoms last longer than 7-10 days. Doctors also consider it a complex concussion if a person loses consciousness (passes out) for more than 1 minute or has seizures after a blow to the head. It's also a complex concussion if someone has had a concussion before, no matter how long ago.

Regardless of the level of concussion, it's best to take it easy for a few days. That means no exercise or activities like skateboarding or gymnastics. If you play sports, never return to a sports practice or game on the day you are injured.

Wait for all symptoms to disappear before you start playing sports again — and that doesn't just mean physical symptoms like headaches or tiredness. In many teens, the physical symptoms get better before the cognitive ones (such as difficulty thinking or making decisions). So it's important to feel 100% before becoming active again.

If You Get a Concussion

Here's what to do if you have a concussion:

  • If you get a concussion while playing sports, stop playing. Don't return to play even if you feel fine.
  • If you've had a complex concussion, contact your doctor or go to the emergency room. After a complex concussion, you must see a concussion or brain injury specialist to help decide whether you need additional tests and when you can return to activity. Ask your doctor who you should see for this.
    For the first few days, rest both your body and mind: Activities that require concentration and attention (like studying, test taking, or even playing videogames) may make the symptoms worse and delay recovery.
  • After the symptoms of concussion have gone away, gradually go back to being more active. Slowly advance from one step to the next, day by day, ONLY if you stay symptom free. The steps for return to play are:
    • No activity until symptoms disappear.

    • Once symptoms disappear, you can start light aerobic exercise such as walking or stationary cycling — no resistance training.

    • If there's still no sign of symptoms, you can begin sport-specific exercise (such as skating in hockey, running in soccer).

    • If you're still symptom free, you can start non-contact training drills (i.e., drills in which there's no chance you will fall, flip, or collide with another player).

    • If steps 1-4 go well, see your doctor to get approval to go back to full activity or training.

If a Friend Has a Concussion

If a friend or teammate seems to have a concussion, tell an adult or coach immediately. Even if the concussion seems mild, a player should sit out the rest of the game.

If the symptoms are severe (such as seizures or a very long period of unconsciousness) or they seem to be getting worse, that's an indication of a serious head injury. Get medical help right away.

What Do Doctors Do?

If a doctor suspects that someone may have a concussion, he or she will ask about the head injury (such as how it happened and when) and the symptoms. The doctor may ask what seem like silly questions — things like "Who are you?" or "Where are you?" or "What day is it?" and "Who is the President?" Doctors ask these questions to check the person's level of consciousness and memory and concentration abilities.

The doctor will perform a thorough examination of the nervous system, including testing balance, coordination of movement, and reflexes. Sometimes a doctor may order a CT scan (a special brain X-ray) or an MRI (a special non-X-ray brain image) to rule out bleeding or other serious injury involving the brain.

If a person's symptoms last longer than a week, the doctor will likely recommend further testing of thinking, memory, reaction time, and other brain functions.

At Home

If the concussion isn't serious enough to require hospitalization, the doctor will give instructions on what to do at home, like having someone wake the person up at least once during the night. If a person with a concussion cannot be easily awakened, becomes increasingly confused, or has other symptoms such as vomiting, it may mean there is a more severe problem that requires contacting the doctor again.

If someone has a concussion, the doctor will recommend rest. Resting and avoiding physical exertion or sports is essential to the healing process. It is also important to avoid loud, bright, busy environments. People who are getting over a concussion should also avoid activities that require lots of thinking and concentration, so a doctor may recommend that the person stay home from school or work.

The doctor will probably recommend that someone with a concussion take acetaminophen or other aspirin-free medications for headaches.

After a Concussion

After a concussion, the brain needs time to heal. It's really important to wait until all symptoms of a concussion have cleared up before returning to normal activities. The amount of time someone needs to recover depends on how long the symptoms last. Healthy teens can usually resume their normal activities within a few weeks, but each situation is different. A doctor will monitor the person closely to make sure everything's OK.

Someone who has had a concussion and has not recovered within a few months is said to have post-concussion syndrome. The person may have the same problems described earlier — such as poor memory, headaches, dizziness, and irritability — but these will last for longer periods of time and may even be permanent.

If someone has continuing problems after a concussion, the doctor may refer him or her to a rehabilitation specialist for additional help.

Preventing Concussions

Some accidents can't be avoided. But you can do a lot to prevent a concussion by taking simple precautions:

  • Always use a seat belt. If you drive, be attentive at all times, and obey speed limits, signs, and safe-driving laws to reduce the chances of having an accident. Driving rules and regulations were created to protect everyone. Never use alcohol or other drugs when you're behind the wheel. There's a reason it's illegal: Alcohol and drugs make your reaction time slower and impair your judgment, making you much more likely to have an accident.
  • Wear your helmet. Wearing appropriate headgear and safety equipment when biking, blading, skateboarding, snowboarding or skiing, and playing contact sports can significantly reduce your chances of having a concussion. By wearing a bike helmet, for instance, you can reduce your risk of having a concussion by about 85%.

It's vital to take good care of yourself after a concussion. If you reinjure your brain during the time it is still healing, it will take even more time to completely heal. Each time a person has a concussion, it does additional damage — and since it's damage no one can see on the outside, there's no way of knowing how serious it might be. If someone has multiple concussions over a period of time, it can affect the person's brain as much as being knocked unconscious for several hours.

Preventing concussions is mostly common sense. The best thing you can do to protect your head is to use it.

Reviewed by: Yamini Durani, MD
Date reviewed: April 2009


Related Sites

Brain Injury Association
National Center for Injury Prevention and Control (NCIPC)
National Athletic Trainers' Association

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