Concussion - Recognizing the Symptoms

"Coach, I have a headache", those five words make every coach grimace, dreading the worse, hoping the athlete does not have a concussion.  A headache is the most common symptom of concussed athletes, but by no means the only one.  No one concussion sign or symptom is more important than the others and all must be taken seriously. To start we will define the difference between signs and symptoms.  A sign is something that you as the coach, parent, trainer or fellow athlete will notice.  They include poor balance, slow or slurred speech, poor concentration, vacant stare, delayed response to questions and a change in the level of performance.  Symptoms, how the athlete tells you they feel, fall under four categories.  Somatic (physical), emotional, sleep disturbances and cognitive.  Somatic symptoms include headaches, nausea, vomiting, balance problems, visual disturbances, dizzy spells, sensitivity to light and sensitivity to noise.  Emotionally an athlete may be sad, depressed, nervous and more irritable.  They may sleep more or less and may have trouble falling asleep.  Cognitively, they may have difficulties concentrating, trouble with remembering, feel mentally slowed down or that they are in a fog.

If an athlete presents with any of these signs or symptoms they need to be removed from activity immediately and evaluated further.  As a coach, parent or trainer, use the Sport Concussion Recognition Tool to determine what further care is needed and refer them to a trained health professional in the area of concussions.  It is very important to rule out a cervical spine injury as well with any athlete that is displaying concussion symptoms.  Typically concussion symptoms are quick in there onset and involve short lived impairment for the athlete.  It should be noted though that in some cases signs and symptoms are delayed in their onset.

Next to knowing what signs and symptoms to look for the greatest tool you need comes from knowing your athletes.  Being able to recognize the difference in your athletes is key.  An athlete may tell you that they do not feel right and if you ask many parents and coaches who have dealt with concussions will say the athlete was not themselves.  Even though they are symptoms take notice of them.  Coaches one of your biggest indicators to watch will be how well the athlete is performing.  If a skill typically always done well can is being done poorly, something is causing it.  Remove the athlete and evaluate, it may not be a concussion but no matter what it is always better to error on the side of caution.  Parents, pay attention to how your child is acting.  They may not tell you they are suffering but you will notice changes in their behavior.  Everything from how they are sleeping, eating and interacting with the family and friends will be an indicator of how they are feeling.

Many of the former athletes when asked about concussions will say they never knew that they had one and definitely did not know what to do when did occur.  Recognize that a concussion has occurred and remove the athlete from activity, do not let them return until evaluated by a trained health care professional. Next is proper management, following the proper return to play can be the difference from a quick return to activity or the unnecessary lengthening of symptoms.

Concussion - Where to Start

Concussions, after staring at my computer screen for about an hour trying to come up with a new and inventive way to talk about concussions and why everyone in sport needs to be educated about them, I realized that their is nothing new to say.  The message is still the same, hopefully you will gain some new knowledge or understanding after spending some time reading this.  That is my hope, that by a coach, parent or athlete reading this, they will learn something about concussions.  We can't necessarily prevent concussions unfortunately it is one of the risks of sport, but we do need to increase the awareness of signs and symptoms and proper management when they do occur.

This may seem like a redundant thing to say but a concussion is a brain injury.  I state this because I have had a coach in the past say a kid could play because the emergency physician said he had a mild brain injury.  He must have been listening to me, he knew that he could not play a kid with a concussion, and obviously I had not educated him enough. As defined from the 4th Concussion Consensus Statement from Zurich November 2012, concussion is a brain injury caused by a direct blow to the head, face, neck or an impulsive force being transmitted to the head from a direct blow to somewhere else in the body that causes a set of physical, cognitive or somatic symptoms.  It is important to say that everyone person will respond differently to a concussion both in the symptoms they show and how they recover.

Every day it seems there is something new coming out about concussions.  For a coach or parent trying to keep up at times seems impossible.  I have found Twitter to be an excellent resource.  Follow health professionals who are known for concussion research to stay up to date and informed.   It is unfortunate that most general practitioners are not up able to stay up to date on the latest concussion research and proper return to play.  When dealing with any health professional ask them questions, if they have never heard of the consensus statements or are still following the earlier versions find someone new.  A great resource is a certified Athletic Therapist in Canada or Athletic Trainer in the States.  Proper concussion management is in their scope of practice and they deal with sport concussions on a regular if not daily basis.

So as a parent or coach what do you need to know.  We are going to break it down into three posts.  First we will focus on the importance of baseline testing, secondly recognizing a concussion, thirdly proper management.

Baseline concussion testing can involve a couple of different aspects.  Depending on your health practitioner they may choose to do a different test.  The most popular and common are the Sport Concussion Assessment Tool 3 (SCAT3), ImPACT and King-Devick.  The SCAT3 has a version designed specifically for athletes aged 5-13 as well as the standard for those 13 and over.  ImPACT should be used along with the SCAT3 or King-Devick.

The importance of having baseline testing done is not to compare to other athletes but to understand the athletes normal state as well as to determine their past concussion history.  Finding out if an athlete has suffered a concussion before and if they have any medical conditions that may effect their recovery from a concussion if one should occur.  Athletes, coaches and parents always ask if the baseline test was passed.  This is where the naming can be deceiving, baseline testing is not a pass or fail, it is to determine how the athlete normally feels to a set of symptoms and to evaluate their memory recall, balance and thinking skills.  It is an evaluation.  How many of us have a headache on a regular basis?  Since headache is the number one symptom of concussion, it is good to know if the athlete regularly has a headache when trying to determine if a concussion has occurred.  When doing baseline evaluations athletes typically tell me they have a hard time with numbers or remembering months.  If we had not done the baseline evaluation I would not have known that and it could effect my evaluation of them post injury.

Education about concussions is always important but that includes the health practitioners education about each individual athlete.  Doing baseline evaluations allows us to get to know the athletes better, which in turn gives us an advantage when an injury does occur.  Have your athletes do baseline evaluations prior to each season as their physical and mental growth and development will change their outcome.  Think of a baseline concussion evaluation as an insurance policy.  We never want to have to use our insurance but are sure glad we have it when it is needed.