youth contact sports

By: Dr. Ciro Errico and Dr. Terry Weyman

Concussions are a big part of every sport. Being on the sidelines of different sports, I see many injuries including concussions. But, what exactly is a concussion?

Before I begin to explain concussions, let me cross out the myth about a concussion being only a direct trauma or hit to the head, and/or a complete loss of consciousness. Another big myth is that a concussion is a bruise to the brain. Both statements are incorrect.

A concussion is a physiological change in the brain induced by a biomechanical force. A force can be applied anywhere on the body causing an ‘impulsive’ force transmitted to the head. This transmitted ‘impulse’ to the head causes a short lived impairment of neurological functions that can resolve spontaneously, but some neurological functions can come on immediately, after several minutes, or hours after a trauma.[1]

Signs and symptoms of a concussion that often go unnoticed are: feeling ‘foggy’, headaches, feeling overly emotional, unexplained sadness, irritability, forgetfulness, slow reaction time, sleepy, and insomnia. When someone is having one of these symptoms (and there is a mechanism of injury that could dictate the reasons), a concussion must be suspected and a proper assessment must be made by a MD, DO or DC. On the sidelines, an ATC or medic can also evaluate an athlete.

What if the symptoms get worse? If a headache becomes worse, if slurred speech occurs, seizure or convulsion, decrease in coordination – the patient should receive immediate medical attention due to the possibility of a deeper cerebral injury.

Concussions also have different degrees of severity. According to the Cantu guidelines, concussions have several grading scales: Grades I, II, and III. Grade I concussions are not associated with loss of consciousness, and post-traumatic amnesia is either absent or less than 30 minutes in duration. Athletes may return to play if no symptoms are present for one week. Grade II is a loss of consciousness for less than five minutes or exhibit post-traumatic amnesia between 30 minutes and 24 hours in duration. They also may return to play after one week of being asymptomatic.Grade III concussions involve post-traumatic amnesia for more than 24 hours or unconsciousness for more than five minutes. Players who sustain this grade of brain injury should be sidelined for at least one month, after which they can return to play if they are asymptomatic for one week.[2]The week begins the day after all symptoms have dissipated.

The reason for the athlete to rest more and be reevaluated is due to the dangers of a possible second concussion also known as Second Impact Syndrome, which is highly dangerous. Here is why: When someone suffers a first concussion, there is a physiological change occurring in the brain that does not allow proper signaling between the synapses. When a second concussion occurs, the brain may lose the ability to properly regulate blood flow causing the brain to swell due to increase pooling in brain. The pooling does not allow the blood to drain causing pressure build-up in the brain ultimately resulting in brain damage and/or death.

So, how do we prevent concussions? Preventing a concussion is hard. There is no real way to prevent a concussion predominantly due to the fact that a concussion does not need to be a direct blow to the head. Concussions can be caused by shoulder charges in soccer, tackling in football, bumping your head on a cabinet door, getting rear-ended in a motor vehicle accident, or even texting while walking and walking into a lamp pole. Concussions, again, are physiological changes in the brain. Headgear and helmets are great for general protection against skull fractures. Mouth guards are also good for preventing an athlete to bite off his tongue, however be aware that when wearing mouth guards, they can cause an athlete to clench his jaw allowing the muscles in the neck and head to tighten up before an impact. This allows less chance of a neck sprain/ strain, but because a concussion is a physiological change in the brain, an athlete may still suffer a concussion. All studies, and including the International Conference on Concussions in Sports, show there are no studies conclusive against protection for concussion.

When managing a concussion, first thing first: parents, coaches, teachers, and teammates need to be aware of the symptoms and get the person properly evaluated. Concussions are difficult to manage due to the severity and, more importantly, due to the physiological changes that occur in the brain. First of all, the athlete or patient should rest. Rest is going to be the key to begin the healing process: this includes resting from training and playing. For young adults, teens, and children resting also means staying home and/or limiting school activities; the information can cause the brain to overwork and as a result decrease healing. Another rest is from technology including video games, TV, computer, phones, and texting because the stimuli that the brain needs to function can overwork the brain resulting in decrease healing time. Secondly, water! Drink plenty of water. Drinking water allows an athlete to stay hydrated, and allows the body to increase healing potential.

What else is available for management? Chiropractic care and adjustments are great with concussions. When someone suffers a concussion there is also a whiplash injury that occurs simultaneously at the upper cervical (neck) area. This causes a physiological change in the muscles surrounding the spine often times causes tightens. It’s putting an extra strain on the neck which in turn will put an extra strain on the healing process for the concussion. Getting adjusted allows less interference on the central nervous system which helps the body change physiologically back to its normal state. Mild Hyperbaric Chamber is another great tool that can be utilized. The hyperbaric chamber increases the oxygen, and pressurizes the body allowing the oxygen to absorb in the body to allow healing to happen at a faster pace.

Concussions affect everyone from the parent to the athlete. For proper healing, it is imperative to understand the first steps to recovery which are understanding what a concussion is and being knowledgable of the best ways for a concussion to heal. When a concussion occurs, it becomes a full effort by everyone to help the athlete reach full recovery.

Dr. Ciro Errico is the Team Chiropractor for California State University-Channel Islands (CSUCI) Lacrosse Team and Newbury Park HighSchool Lacrosse. He is also the Team Chiropractor for Club Sports at California State University-Northridge (CSUN). He is a treating Chiropractor at Chiropractic Sports Institute (CSI)

Dr. Terry Weyman is the Chiropractor for Pepperdine University and works with Extreme Athletes in both Motocross and Mountain bike racing. He is the clinic director of Chiropractic Sports Institute

More info on CSI visit their website www.gotcsi.com

[1]International Conference on Concussion in Sport (Zurich; Nov. 2012)

[2]American Association of Neurological Surgeons

In lieu of the recent tragedy that happened to the young football player in Simi Valley I have felt compelled to put this article together. Please share it with all your friends who participate in high action and contact sports. I have been associated with high action and contact sports for over 20 years and it saddens me when I hear of accidents such as this. Most of these accidents are just that, they are rare accidents. However, understanding brain injuries and knowing what to do is an important part of the “recovery” phase.

I recall an article that addressed head injuries in youth sports. On March 14, 1997, an Issue of MMWR of the Centers for Disease Control and Prevention describes two cases of second-impact syndrome that resulted in deaths. One case involved a high school football player in 1991 and the other a college football player. In each case, the player did not require hospitalization, and each player was sent home for close monitoring with no follow up guidelines. The American Academy of Neurology has developed guidelines for preventing second-impact syndrome and reducing the frequency of other cumulative brain injuries. These are different than the “Famed” Colorado guidelines and air on the side of being conservative.

Summary of Recommendations for Management of Concussions in Sports

The most common head injury is the concussion. Concussions are a form of brain injury that should not be taken lightly. The after effects of a concussion, post-concussion syndrome, can linger for days or weeks. Concussions are an unfortunate side effect of collision sports such as football, hockey, lacrosse, motorcycle and bicycle riding. They range in severity from the minor (“I just had my bell rung”) to major, life threatening brain contusions (“he was knocked out cold”).

A concussion is defined as a clinical syndrome characterized by immediate and transient post-traumatic impairment of neural function owing to mechanical forces. A concussion occurs when the body is moving rapidly through space and suddenly stops. Keep in mind that the brain is traveling at the same velocity as the rest of the body. When the body suddenly stops, the brain continues to move at the same velocity in the same direction. The brain then hits the skull and bounces back, hitting the opposite side of the skull until it loses momentum. This occurs due to the fact that the brain is floating in the cerebral spinal fluid, and does not actually touch the skull.

When the brain strikes the skull, a portion of it is damaged. When enough damage is done, it begins to operate improperly. This is when the outsider notices the symptoms of the concussion. The effects of these repeated blows to the brain are cumulative, that is, one blow intensifies the effects of the previous. Because of this, an athlete may take what appears to be a slight blow to the head or body and then show the symptoms of the concussion.

There is no standard classification system for concussions. Four of the leading researchers in head injuries maintain their own classification system. The symptoms of each degree of concussion are often very similar, and it is easy to be confused when assessing a head injury. However, the latest protocol that is recognized as the leader is the information by the ANA (American Neurological Association).

Definitions from the ANA and treatment recommendations for each category are presented below.

Grade 1 Concussion

• Definition: Transient confusion, no loss of consciousness, and a duration of mental status abnormalities under 15 minutes.

• Management: The athlete should be removed from sports activity, examined immediately and at 5 minute Intervals, and allowed to return that day to the sports activity only if post concussive symptoms resolve within 15 minutes. Any athlete who incurs a second Grade 1 concussion on the same day should be removed from sports activities until asymptomatic for 1 week.

Grade 2 Concussion

• Definition: Transient confusion, no loss of consciousness, and a duration of mental status abnormalities15 minutes or longer.

• Management: The athlete should be removed from sports activity and examined frequently to assess the evolution of symptoms, with more extensive diagnostic evaluation if the symptoms worsen or persist longer than 1 week. The athlete should return to sports activity only after being asymptomatic for 1 full week. Any athlete who incurs a Grade 2 concussion subsequent to a Grade 1 concussion on the same day should be removed sports activities until asymptomatic for 2 weeks.

Grade 3 Concussion

• Definition: Loss of consciousness either brief (seconds) or prolonged (minutes or longer).

• Management: The athlete should be removed from sports activity for I full week without symptoms if the loss of consciousness is brief or for 2 full weeks without symptoms if the loss of consciousness is prolonged. If still unconscious or if abnormal neurologic signs are present at the time of initial evaluation, the athlete should be transported by ambulance to the nearest trauma hospital. An athlete that has suffered a second grade 3 concussion should be removed from sports activity until asymptomatic for 1 month. Any athlete with an abnormality on CT or MRI brain scan consistent with brain swelling, contusion, or other intracranial pathology should be removed from sports activities for the season and discouraged from future return to participation in contact sports. Source: New standards for head trauma subcommittee, American Academy of neurology 1997

With any head injury the patient needs to be monitored (no matter what the patient says, does or thinks) by a parent, mature teammate or friend. Since a head injury can alter mental function, personality and the ability to make clear and well thought out decisions, sometimes the decisions are left up to the “significant other”. Following any head injury a comprehensive exam should follow to insure the athletes safety. Also, knowing what to do if any injury occurs can mean the difference, at times, between life and death.

Patient instructions following a head injury

Before I tell you what not to do if you SUSTAIN an injury, I need to address a common problem that many athletes do prior to “game time”. Since a concussion is essentially a “bruise to the brain” anything you take prior to participation that could thin the blood is not recommended. If you participate in any high impact sport DO NOT take aspirin, advil, alleve or any other supplement or medication prior to participation due to the fact that this could thin the blood and make ANY bleed worse.

Common symptoms of a head injury include: headaches, nausea and slight dizziness. There may be swelling and pain at the site of impact. A head injury can cause slow bleeding or other problems inside the head that may not be detected at the initial exam. Make sure you consult any health care provider if any symptoms change or worsen.

Home treatment:

• Do not take any sedatives or sleeping pills
• Do not take aspirin, ibuprofen, motrin, advil, alleve, nuprin or any other medication that can thin the blood
• If needed, the use of acetaminophen (Tylenol) is recommended for pain only
• Do not drink alcohol or tea
• Do not exert yourself or participate in PE (follow guidelines above)
• Do not eat or drink much for the first 24 hours (clear liquids are the best)
• Sleep with head slightly elevated
• Avoid hot tubs and Jacuzzis for the first 48 hours

I hope this information is helpful to anyone involved with high action or contact sports. Be safe so you can play another day! Please pass this on to anyone you may know and have them sign up for our newsletter for more upcoming tips. www.gotcsi.com

Concussions- what you need to know!

Guidelines for Head injuries in contact sports

About Dr. Terry Weyman

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