Get the facts about concussions and forget the myths
As the days get longer and warmer, folks will head outside more often, and with kids at play and spring sports underway, the risk of injuries increases — including the risk of concussions.
The International Concussion Society reports that between 1.6 million and 3.6 million concussions occur in the U.S. each year.
But what is a concussion, exactly? A concussion is a type of traumatic brain injury, or TBI, caused by a blow to the head or body, a fall or other injury that jars the brain inside the skull. A person may have bruises or cuts on the head or face, but sometimes obvious physical signs of an injury are not present.
“Any time a blow to the head results in symptoms, you should seek medical attention,” said Dr. Karen Evans, a physician with Mt. Oread Family Practice. “In a best-case scenario, it’s just a safety precaution. But in the early stages, it’s very hard to sort out which symptoms are signs of a more serious injury. Some symptoms progress over hours or days, so it’s important to treat all of them seriously.”
Common symptoms of a concussion include:
• Nausea and/or vomiting
• Blurred vision
• Balance issues
• Sensitivity to light and/or sound
• Feeling in a “fog”
• Difficulty concentrating or remembering
Anyone who experiences “red flag” symptoms such as seizures, worsening headache, repeated vomiting, weakness or numbness in the arms or legs, inability to wake or slurred speech, should head to the emergency department for an immediate evaluation.
Athletes in high-risk sports, such as football or soccer, are particularly susceptible to concussion, but it can happen with any sport. During competition, an athletic trainer may perform a sideline evaluation, which includes asking about symptoms and performing a brief exam.
Many area schools have an athletic trainer who works directly with student-athletes to help keep them safe. OrthoKansas, a regional destination for comprehensive, state-of-the-art musculoskeletal care, and LMH Health employ athletic trainers at six area schools, including Free State and Lawrence High, Baldwin City, Basehor-Linwood, Eudora and Tonganoxie.
Jamie Blackim, the OrthoKansas athletic trainer at Lawrence High, said that if a concussion is suspected, an athlete should be immediately removed from play.
“After the athlete is removed, the athletic trainer will take them through a Sports Concussion Assessment Tool (SCAT), which is used by medical professionals and qualified health care professionals to aid in evaluating athletes suspected of having a concussion,” she said. “The SCAT has us look at observable signs of a concussion, cervical spine evaluation, symptom evaluation, immediate memory, concentration, neurological screening and delayed recall for memory.”
Time to see a physician
Dr. Emily Heronemus, a sports medicine physician at OrthoKansas, provides athletes of all ages with comprehensive sports care, including concussion care. One of the first steps is a comprehensive evaluation.
“When a patient comes to see me, I take a thorough history to learn how the injury occurred, what their symptoms were following the injury and what they’re currently experiencing,” she said. “I also need to know how the patient has been sleeping and if they’ve been able to return to school or work. We then complete an exam that includes a neurological exam, balance assessment, and sometimes testing vestibular and ocular function.”
Recovering from a concussion takes time. Symptoms in adults and older adolescents most often resolve within two weeks, while it can take up to four weeks for younger athletes.
“The mainstay of treatment is rest, both mental and physical, with a gradual progression back into activity,” Heronemus said. “Your physician may recommend starting light activity, such as jogging or a stationary bike, but patients won’t be allowed to return to full participation in their sport until symptoms have fully resolved. They must complete a gradual, step-wise return to play progression, usually over a span of five days.”
Both Heronemus and Evans agree that “return to learn” is just as important as “return to play.” Return to learn is a step-by-step progression that helps student-athletes get back into the classroom following a concussion.
“When we’re trying to get athletes back to play, we start very gradually,” Evans said. “Our first goal is to get the student back to school. That’s a good indicator if they’re ready to get back onto the field or court.”
Blackim said that getting students back into the classroom may require an individualized transition and accommodations. Over the past year, she has seen more students who have needed classroom accommodations – something she thinks may be attributed to virtual learning.
“One of the things we tell athletes who have been diagnosed with a concussion is to limit their screen time. When you have to attend class using a virtual platform, that makes the return to learn much harder,” she said. “The bright lights of the screen can prolong symptoms and make it harder to return to sports as fully and quickly as they might be if they were in the classroom instead of on a computer.”
Not just athletes
Athletes aren’t the only segment of the population that end up with concussions. Concussions can occur in a variety of ways, including falls at home or work and other accidents.
“I most commonly see younger athletes – middle or high school age – but I’ve also seen patients referred from the emergency department,” Evans said. “They’ve had work-related accidents, motor vehicle accidents, or falls where their symptoms are similar to a concussion.”
Patients with severe concussions or symptoms that linger may be referred to a neurologist. Lawrence Neurology Specialists is an LMH Health clinic that treats patients 18 and older. Younger patients who require a visit to a neurologist should consider visiting a specialist like those at Children’s Mercy Hospital in Kansas City, Mo.
One of the long-term diagnoses that a neurologist treats is persistent post-concussive symptoms, or PPCS. PPCS can cause headaches and affect cognition and memory, as well as other issues for several months. Over time and with treatment, many patients see their symptoms improve.
Many of us have heard that if you suspect someone has a concussion, you have to wake them up every half hour to make sure they’re OK.
“That’s a commonly held myth,” Heronemus said. “If you suspect a concussion, you don’t need to continually wake the person up. Sleep is beneficial for someone with a concussion, so it’s better for them if you just let them sleep.”
Other common myths:
• Helmets prevent concussions. While helmets can prevent skull fractures or other serious injuries, they don’t prevent concussions. If your brain is jarred, it can cause a concussion – even if you’re wearing a helmet.
• You have to hit your head to get a concussion. Concussions are caused by an injury that shakes the brain inside the skull. They can occur from whiplash and rotational injuries such as being violently shaken or being in a car crash.
• You don’t have a concussion if you don’t have immediate symptoms. While symptoms of a concussion may be apparent immediately following an injury, sometimes symptoms won’t show up for hours or even days.
“If you think you might have a concussion, don’t hesitate to reach out to us at OrthoKansas or Mount Oread Family Practice,” Heronemus said. “We can provide most of your care at the LMH Health West Campus – medical care, imaging, physical therapy – all in a one-stop shop. We have caring, compassionate teams to give you a comprehensive, personalized experience.”
— Autumn Bishop is the marketing communications manager at LMH Health.