Medical Edge Newspaper Column

Concussions In Sports Should Be Watched For And Treated, Not Dismissed

March 6, 2008
Dear Mayo Clinic:
My son is starting hockey, and I'm worried about potential concussions. How can they impact a teenager long term?

Answer:
I understand your concern. A concussion can occur in any sport, but participants in contact sports like hockey, football and soccer have a higher risk of concussions. More than 250,000 concussions occur each year in the United States in high school football alone. Concussions should be taken seriously because recurrent injuries can lead to permanent brain damage. Fortunately, though, most concussions are minor and, with proper care, they usually don't cause long-term injury.

A concussion is a type of brain injury. The fluid that surrounds your brain inside your skull (cerebrospinal fluid) cushions and protects the brain from daily jolts and bumps. But, that fluid sometimes isn't enough to protect the brain from a sudden stop or a blow to the head. In those situations, your brain may slide forcefully against your skull, resulting in an interruption of brain function that's called a concussion.

As a first step to prevent concussions, all hockey players should wear protective headgear and a mouth guard (to protect the jaw as well as the mouth and teeth). A professionally certified helmet reduces the force of a direct blow to the head, which protects the skull from a fracture and possibly the brain from a concussion. Players should try to avoid a hit to the head, face or neck. They should be aware of the location of the boards and their opponents on the ice. And they should never use their head as a weapon or deliver a hit to an opponent's head.

Also, you, your son and his coaches need to know the signs and symptoms of a concussion, so they can act quickly if an injury occurs. Although concussions are common, they often go unreported because people don't recognize them. The two most common concussion symptoms are headache and confusion. Amnesia can also occur, with a loss of memory for events that occurred just before or after the injury. Other immediate signs and symptoms may include dizziness, ringing in the ears, slurred speech, nausea or vomiting. A person who has sustained a concussion may lose consciousness, but that's usually not the case.

It's critical to identify a concussion when it happens and to remove the athlete from the game for evaluation by a qualified health care provider. When an injured athlete is allowed to return to play, the risk of a second concussion is about four times higher. In addition, multiple concussions that go untreated can cause permanent impairment, including chronic headaches, impaired thinking, memory difficulties, poor sleep patterns and depression.

The long-term health risk to your son is small, though, if he sustains a simple concussion that is accurately diagnosed and promptly treated. The symptoms of a simple concussion resolve within 7 days of the injury. Treatment should include a period of both physical rest and cognitive rest following the concussion to give the brain time to heal. Return to sports should be gradual after all symptoms have cleared. An athlete who has had a concussion shouldn't return to a contact sport like hockey until a health care provider has given approval.

Talk to your son about how he can prevent concussions and make him aware of the importance of recognizing concussion signs and symptoms. Emphasize to him that if he has any of those signs or symptoms after a hard hit, he needs to tell someone so he can be treated right away. Most coaches and trainers now understand that what some might jokingly refer to as "getting your bell rung" in a game is actually a brain injury, and shouldn't be discounted.

— Michael Stuart, M.D., Orthopedic Surgery/Sports Medicine Center, Mayo Clinic, Rochester, Minn.