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CONCUSSION IN SPORT; Awareness for Life

Sport related concussion has become a more carefully studied area of medicine in recent years, particularly in the last decade since the initiation of International Conferences on Concussion in Sport early in the millennium. These conferences, held in Vienna, Austria (2001) Prague, Czech Republic (2004) and Zurich, Switzerland (2008) have gained world-wide recognition as cornerstones in head injury recognition and management. The protocols designed at these symposiums are of increased interest when studying a sport such as figure skating where rotation at high velocity and high impact falls are abundant. This topic is of specific interest for reasons of public knowledge gain and injury prevention in skating.

A concussion is defined as “a complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces” (McCrory et al, 2009). As described by McCrory et al. at the International Conferences on Concussion in Sport, the identified forces are among, but not limited to direct blows to the head, face and neck, the abrupt acceleration or deceleration of the head and neck (whiplash), or a sudden rotational force through the head and neck. These types of forces, often coupled with other traumatic impact throughout the body can cause a jarring of the brain and surrounding tissue resulting in specific symptoms associated with head injury. These symptoms include: headache, nausea/dizziness, tinitus (ringing in the ears), blurred or starry vision, disorientation/confusion/memory loss, delayed response, altered emotional state (unprovoked crying), loss of balance/slurred speech, and loss of consciousness. If any of these symptoms is present after a traumatic event to the head (or elsewhere on the body) that encompasses any of the above mechanisms, immediate medical evaluation is required, and the athlete is not to be allowed to further participate in the competition or practice.
Most head injuries will resolve without complication in a matter of days and an athlete can safely return to their sport with little worry of recurring symptoms. However some more severe injuries will require a prolonged period of recovery in which time an athlete is absolutely not to engage in any physical activity until deemed safe to do so by a medical professional with head injury knowledge and experience.

It is very important that each participant’s medical history be thoroughly examined and that previous head injuries are identified. Previous head injury may increase an athletes risk of subsequent injury depending on the severity and date the injury was initially sustained (Guskiewics et al, 2003). Should an athlete experience multiple blows or mechanical forces in close timing proximity, the severity of the concussion may be exponentially increased (McCrory et al, 2009). This phenomenon is known as Second Impact Syndrome. These repeated injuries within a short period of time can be catastrophic or in some cases fatal (CDCP, 1997). For this reason, it is extremely important, and in the athletes best
interest that if they are experiencing ANY symptoms of head injury, they be removed from activity and examined by a medical professional before being allowed to further participate in any competition or practice. All suspected head trauma must be treated seriously and immediately.

Concussion management and treatment is different in every case. However, one staple in the process is immediate rest! Immediately following any head injury, the athlete should be put at complete physical and mental rest until directed otherwise by a medical practitioner. This rest includes all physical activity, television, reading, video games, or anything else that requires physical or mental stimulus. This rest offers the brain time to heal and will not predispose the athlete to further injury or delayed healing. Based on the medical recommendation for each athletes specific injury, a progressive rehabilitation plan will be prescribed and the athlete is to adhere directly to medical recommendations and STOP at any stage of rehab if ANY symptoms recur. Based on the rehab progression developed at the 3rd International Conference on Concussion in Sport, a six-stage rehabilitation plan of increasing intensity is suggested, which requires a minimum of 24 hours symptom free rest between each phase. This means that the least severe head injury requires a minimum of seven days before an athlete is able to return to competition or high intensity practice. Before an athlete may return to full activity, they must show no symptoms at full exertion and must have medical clearance!

It is extremely important that coaches, parents, team officials and especially the skaters be educated and understand the risks involved with participating in a high velocity sport such as figure skating. Head injuries are far more common than was once believed and DO NOT necessarily need direct impact to the head to occur. By recognizing the mechanisms and symptoms associated with concussions, we can take great steps toward improving our understanding of the injury and taking the appropriate steps to ensure that athletes are treated accordingly and limit the severity and occurrence of the detrimental effects of these ‘invisible’ injuries. In doing so, and becoming aware of the cause and effect of concussions, we can keep everyone safe so they can focus on having fun. Because in the end, that’s what skating is about.

J. Scott Marchant, CAT(C), B.A.H.Sc.
Certified Athletic Therapist / Head Injury Specialist

 

 

REFERENCES

1. Centers for Disease Control and Prevention (CDC) Sports-related recurrent brain injuries- United States. MMWR Morb.Mortal.Wkly.Rep. 46: 10: 224-227, 1997
2. Guskiewicz KM, McCrea M, Marshall SW, Cantu RC, Randolph C, Barr W, Onate JA and Kelly JP. Cumulative effects associated with recurrent concussion in collegiate football players: the NCAA concussion study. JAMA 290: 19: 2549-2555, 2003.
3. McCrory P, Meeuwisse W, Johnston K, Dvorak J, Aubry M, Molloy M and Cantu R. Consensu Statement of the 3rd International Conference on Concussion in Sport, Zurich 2008. Clin J Sport Med. 19: 3: 185-200, 2009

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