Advice for Concussions: When In Doubt, Sit It Out

On July 28, 2011, Northwestern Medicine in Chicago hosted a concussion symposium called “Playing It Safe: Changing the Mindset Around Concussion Safety.”  And a few top-notch physicians were on hand to talk about the effects of concussion.

Concussions are in the news every week these days. Former pro football players are suing the NFL, claiming that they were never warned of the dangerous, sometimes life-threatening effects of concussion. New helmets are being developed to protect brains better after hard hits. And coaches and players alike are receiving training in how to recognize and treat head injuries.

Concussions can happen anytime there is a blow to the head, causing a jarring or shaking that disturbs brain function.

“The brain is like jello, when jello is impacted it’s going to move within the bowl. The same thing applies for a brain; even if it’s the slightest impact the brain is affected,” said Carrie Jaworski, MD, head team physician for Northwestern University Athletics.

It’s easy to see why prevention and protection are so important—imagine trying to use a helmet to protect a bowl of Jell-O. Even the best helmet won’t keep the Jell-O from getting shaken up. And without a helmet, impacts can do even greater damage. Football players’ heads have at least some protection from those giant helmets; gymnasts’ and cheerleaders’ heads do not.

“Concussions aren’t discriminatory; they affect people of all ages and all activities, even in non-contact sports such as gymnastics or cheerleading,” said Hunt Batjer, MD, chair of the department of neurological surgery at Northwestern Memorial Hospital and Northwestern University Feinberg School of Medicine. “In fact, young girls may be at a higher risk than boys when it comes to concussions.”

Tips From the Concussion Symposium

Along with the usual academic discussions, the symposium provided some useful tips, too. Some of the information you may find helpful:

  • Black outs. You don’t have to black out to have a serious concussion. In fact, most concussions don’t result in any black out, of any length.
  • Game-specific signs of concussion. We know the general symptoms of dizziness, confusion, etc. But doctors at the symposium gave specific signs to watch for, which include appearing dazed or stunned; confusion about an assignment or position; forgetting a play; uncertainty of game, score, or opponent; moving clumsily; answering questions slowly; losing consciousness (even briefly); behavior or personality changes; and the inability to recall events before or after a hit or fall.

“If an outgoing and boisterous athlete on your team suddenly becomes quiet or withdrawn, this is a cue that the player needs to be taken out and evaluated. The signs can be very subtle, but if you feel like something is wrong, you need to assume it is,” said Adam Bennett, MD, sports medicine physician at Northwestern Memorial and assistant professor of family and community medicine at the Feinberg School.

  • Second Impact Syndrome. Athletes who resume playing too soon after a concussion are at a greater risk for second impact syndrome, which can cause the brain to swell rapidly—a serious medical emergency. This occurs when a second head injury happens before the child recovers from the first concussion. Because the second hit happens when the brain is still injured, it is more vulnerable to additional injury…perhaps permanent, serious, irreversible injury.
  • Encourage open dialog. Players need to know that talking about their symptoms is “safe”—that they will be respected for being open about their injury, and rewarded for taking time to heal. According to Dr. Batier:  “Players can shake off pain in the leg, but they should understand that they should never shake off a head injury.”
  • Sidelining players. All players need to be sidelined until all symptoms have disappeared—that means not only the obvious physical symptoms of headache or blurred vision, but also normal concentration and resuming normal patterns of eating and sleeping. This could take three weeks…it could take three months or longer. For coaches and parents of youth athletes, this translates to a simple rule:  When in doubt, sit them out.

Also highlighted at the symposium were concussion war stories, such as this one from former football great Dan Hampton, from his years playing professional sports:

“I played during what I call the ‘crash-test for dummies’ period. Players would get hit so hard they wouldn’t even know how to walk off the field,” said Hampton. “I wish these discussions happened back when I played. Today most people are aware of the effects of a concussion, that wasn’t the case when I played.”

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