With the onset of warm weather and the spring soccer season, I am bracing for the recurrent questions regarding concussions. Such is the life of a dad physician cheering from the sidelines. Though it is true that the fast pace, aggressive play, and frequent hard contact of soccer are a set up for this injury, many other mechanisms can be at play. Most associate concussions with high impact, high velocity incidents; however, even less forceful traumas can be the cause, particularly when sudden and rapid head movement is also associated. This knowledge is important: 1) we need be vigilant that, though helmets are helpful in reducing fractures and some contact forces upon vital structures, they do not add full protection against shearing forces and resulting injuries; 2) we must be observant with even less forceful injuries, such as an elbow to the head, standing up an hitting your head on a low beam, or a fall even when no obvious impact occurs, to give a few examples.
It cannot be emphasized enough how important it is to recognize concussions quickly and to respond accordingly. This is easier said than done with a competitive group of young healthy players (even some parents who often live vicariously through them) who minimize symptoms and want to continue on at all costs to win the game regardless of how they are feeling (even as they struggled to bring down a load of laundry the morning of the game). Though there is no actual treatment, it is important to take precautions and to prevent recurrent injury, particularly in the first several weeks. Recurrent concussions are associated with permanent deficits in memory, concentration, learning, and even emotional stability.
Concussion is likely when one notes early on some obvious findings:
- loss of consciousness, sleepiness, or confusion
- double vision
- stumbling, dysequlibrium, dizziness
- amnesia of the time period around and including the event
- severe headache
- severe nausea, with or without vomiting.
If any of these occur, the injured person should seek immediate medical attention. Your doctor will determine if imaging studies are necessary (e.g., severe symptoms early on, or symptoms lasting more than 12 hours).
Players and family must also be vigilant to more subtle signs of “post-concussive syndrome,” signs and symptoms of which can persist for months in some cases:
- ongoing new difficulties with concentration, memory, learning
- persistent stomach upset
- altered sleep patterns ranging from insomnia to sleeping more than usual
- double or blurred vision
- impaired balance, stumbling, or falling
- new onset of ongoing fatigue starting after the injury.
- increased symptoms with exertion
These lists are not all-inclusive, and particularly regarding post-concussive syndrome. However, to prevent permanent damage or missing a diagnosis of something serious, these symptoms should be discussed with your doctor to determine if further evaluation is necessary, and how rapidly they need to be done. If you’re a member of a direct primary care practice like ours, you can text your doctor from the sidelines and alert them quickly to what’s going and have a plan of action quickly.
Once a concussion is presumed or diagnosed, then, a detailed, collaborative plan with your doctor should be developed for return to play (for the athlete) or activity. We at Alpha Omega Elevation + Wellness are readily available to walk with you through this process from beginning to end. Management of a concussion looks like complete mental and physical rest until symptoms resolve. Yes, that even means no homework. But, before your student gets too excited to binge watch their favorite show, that means NO screen time whatsoever. Complete brain rest.
Returning to “normal activity” is slow and done in stages. Starting with a return to academics first. Each stage is completed and then reevaluated for symptoms before moving on until regular activity is tolerated.