Concussions have been receiving a lot of attention within the Sports Medicine community, and in the media, for some time now. It is also one of the most common injuries we see in our Sports Medicine clinics. As an Athletic Trainer, I’m frequently asked about injury recognition, treatment, and return-to-play criteria. While these topics are far too expansive for one post, I’d like to address several, common misconceptions surrounding concussions.
Myth #1: I just got my bell rung. Or, “I just got dinged.” Both of these phrases indicate the brain has been affected in some way and is often because a concussion has occurred. If an athlete is feeling this way, he or she should be evaluated by a medical professional to determine the exact nature of the problem and if it is safe to return to play.
Myth #2: A concussion is a bruised brain. Rather, a concussion is a functional injury so it affects how the brain works. This is why concussion symptoms can include difficulty remembering, trouble concentrating, and feeling slowed down.
Myth #3: The CT Scan was normal, so it’s not a concussion. This goes along with Myth #2. Concussions do not involve injury to the brain structure, so they cannot be seen on a CT scan (also known as a CAT scan), MRI, or x-ray. Diagnosing a concussion is based on how the injury occurred and symptoms the athlete is experiencing. The aforementioned diagnostic tests are used to rule out other types of problems, such as bleeding in the brain, and are normal in the vast majority of concussions.
Myth #4: One must be hit in the head in order to sustain a concussion. While the majority of concussions do involve a blow to the head, or hitting the head on something such as the ground or a wall, it is possible to get a concussion when the head suddenly moves or changes its direction of movement. An example of this would be a football player, who was running full speed when he was hit in the chest by a tackler. The impact immediately stopped his momentum and caused his head to snap forward quickly.
Myth #5: If the athlete isn’t “knocked out,” it’s not a concussion. In reality, fewer than 10% of concussions involve a loss of consciousness. In some cases, a headache is the only symptom an athlete may experience, but if it occurs after a blow to the head, it creates a concussion. However, if the athlete does lose consciousness, it’s generally a safe bet that he or she has sustained a concussion and should be evaluated by a medical professional such as a physician or Athletic Trainer.
Myth #6: Symptoms of a concussion will begin as soon as the person is hit in the head. Not always. In many cases, symptoms will begin immediately or within minutes, but symptoms can evolve 24-48 hours after the initial injury. Some athletes may sustain a blow to the head and think they are fine for a few hours, but they will then wake up with a painful headache and sensitivity to light or noise the next morning. This is why an athlete should never be allowed to return to play on the same day the injury occurs. Here in Ohio, our concussion law specifically states just that.
Myth #7: It’s ok to play through a concussion. Absolutely not. The greatest danger in playing through a concussion is a rare, but catastrophic, condition called Second Impact Syndrome that results in either death or permanent, life-altering changes in the person’s ability to function normally. Second Impact Syndrome has only been found in people younger than age 21, and occurs when the athlete sustains a second (sometimes seemingly innocent) blow to the head before the initial injury has resolved. Additionally, playing through a concussion will prolong or worsen the symptoms because the brain needs physical and mental rest in order to recover.
Myth #8: Certain helmets, helmet add-ons, and headgear can help prevent concussions. There is no scientific evidence that strongly supports any type of equipment’s ability to prevent a concussion. Helmets—football, lacrosse, ice hockey, and others—are designed to prevent skull fractures, not concussions. However, it should be noted that a properly fitted, well-maintained helmet is very important to wear, so that it can function the way it is designed to. There are also several devices on the market that claim to reduce the risk of concussion, which again isn’t supported by research. These include mouth guards, headbands, and football helmet add-ons. Lastly, helmet add-ons can void the manufacturer’s warranty and aren’t approved by the National Operating Committee on Standards for Athletic Equipment (NOCSAE).
Myth #9: My headache is gone, that means I’m fine. Not necessarily. Headache is merely one symptom of a concussion, and there are a variety of others that can persist after it’s gone, including sleep disturbances and difficulty concentrating. In some cases, the athlete’s symptoms may have completely resolved but cognitive function hasn’t yet returned to normal. One method to help determine this is called neurocognitive testing, and it can be very helpful if the athlete has a baseline test. Baseline testing evaluates certain aspects of brain function before an injury, and the test can then be repeated after a concussion for comparison by a medical professional. While neurocognitive testing isn’t the only consideration in return-to-play decisions, it can be valuable information and is one piece of the puzzle. The bottom line is that all concussions, or suspected concussions, should be evaluated by a medical professional before the athlete returns to play.
Myth #10: Kids’ brains are the same as adult brains. The human brain continues to develop until about age 25. This is why kids can take longer than an adult to recover from a concussion and they are more likely to sustain one in the first place.
Our Concussion Toolkit is available. And it’s free. It includes educational guides specific to each member of a concussion management team, so that parents, coaches, educators and school administrators, along with the athletes themselves, know what a concussion is, how to manage symptoms, and what to do to get better faster. We’re also available to answer questions on our Facebook page, Twitter feed, or via email at Sports.Medicine@nationwidechildrens.org.