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The season of concussions

As we are now full swing into the high school sports season, it's a good time to discuss concussions.

There is quite a bit of debate and misunderstanding in the management of concussion.

Over the years, there have been no less than 16 different guidelines to determine the severity of a concussion. This has led to confusion in determining when it is safe to let an athlete return to play following a head injury.

As we have learned more about the dangers of concussion, there has been a shift toward more conservative care.

When I first began attending sports events as an athletic trainer 20 years ago, athletes routinely talked about playing with a concussion, or "ding" injury. It was thought of as a badge of courage to continue playing (many dads of athletes share their concussion stories with me on the sidelines).

We know now that this is a very dangerous practice.

A concussion is defined as a change in mental status that results from some type of trauma force to the brain. The brain has the ability to shift somewhat within the skull. When a mechanical force is applied (i.e., striking your head from a fall, making a tackle, colliding while playing soccer), the brain can be injured, causing biochemical changes in the brain cells.

A common mistake is to think that this brain injury must lead to a loss of consciousness before it's labeled a concussion. Symptoms such as disorientation, memory loss, concentration difficulties, personality changes, headache, poor coordination, nausea and vision problems, may be present alone or in combination. These are also symptoms of concussion.
The severity of a concussion is often categorized in grades. Grade 1: symptoms last no longer than 15 minutes. Grade 2: symptoms last for longer than 15--30 minutes. Grade 3: Any loss of consciousness.

The guidelines also include varying criteria on when it is safe to return to play. A common practice in the past was to allow athletes to return to play if all symptoms were gone in 15 minutes.

Research has now shown that in even these Grade 1 concussions, the biochemical injuries that occur to the brain may take up to 5-7 days to recover. So even though there may be no outward signs of concussion, the brain may not be fully recovered. This has led to a more conservative approach to letting athletes return to play, even after the mildest concussion.

The label for letting an athlete play before completely recovered is "second impact syndrome." This occurs when the athlete sustains another jarring force to the brain, causing the brain to bleed. This could lead to sudden death.

Another potential complication is known as post-concussion syndrome. This occurs when the the biochemical changes in the brain do not reverse. This can sometimes lead to symptoms lasting for weeks or months after injury.

Other things to keep in mind: the younger the athlete, the more susceptible he or she is to concussion. Once you have had a concussion, you are four times more likely to suffer another one. The more concussions you have, the longer it takes you to recover from each one. The symptoms could eventually become permanent. An athlete's symptoms may seem to be gone at rest, but they quite often return with even low-level exertion.

With any sign of concussion, the safest route is to follow up with a doctor.

Dr. John Leddy, associate director of UB Sports Medicine, contributed to this article. Michael Adesso is director of Physical Therapy and Athletic Training at University Sports Medicine's Youngs Road office. E-mail him at M_Adesso@hotmail.com

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