Jordan Metzl

Concussions In Young Athletes

by Jordan Metzl, posted August 4 2009

What is a concussion

Although there is no universally recognized definition of a concussion, it generally includes any traumatically induced alteration in mental status that may or may not involve loss of consciousness. Common symptoms include:

  • Confusion
  • Headache
  • Nausea
  • Vomiting
  • Dizziness
  • Unsteadiness
  • Fealing "in a fog"

Who gets a concussion?

Participants in contact and collision sports are especially susceptible to concussions. It has been estimated that 300,000 sports-related concussions occur every year and that 63% of these injuries are suffered by high school football players. In fact, 20% of all high school football players are believed to receive a concussion annually. Other sports that are associated with mild traumatic brain injuries are soccer, wrestling and boxing. Athletes who are not expecting a sudden impact suffer most concussions.

What are the different types of concussions?

There are three different grades of concussions for which doctors systematically evaluate. The symptoms for the three types are shown below.

Grade 1 (mild) Grade 2 (moderate) Grade 3 (severe)
Concussive symptoms that clear under 15 minutes such as headache, dizziness and memory loss Concussive symptoms that clear in greater than 15 minutes Loss of consciousness for any amount of time

The key rule to observe is that an athlete who has sustained a concussion should not be allowed to return to play while still displaying symptoms. In general, athletes who suffer a concussion should consult with their physician prior to returning to competition.

How do you treat someone who gets a concussion?

Treatment of a concussion is based on the severity of the head injury suffered. The following chart describes the course of action generally followed after an athlete has been evaluated and the grade of concussion has been determined.

Grade 1 (mild) Grade 2 (moderate) Grade 3 (severe)
Remove from game and examine every 5 minutes. May return to play if there are no symptoms within 20 minutes Remove from game. May not return to competition for 1 week from time of resolution of symptoms with exertion Remove from game and transport to local emergency department. Eventual referral to neurologist prior to resumption of contact sports

It is very important that an athlete who has suffered a concussion be examined frequently, even following return to play, and should not be left unattended until all symptoms have ceased and examinations are completely normal. Concussions are serious injuries, and return to activity afterwards is an important consideration.

What is the prognosis for an athlete who has sustained a concussion?

Many athletes who suffer mild concussions will return to normal mental status and be able to return to play soon after injury, provided that all symptoms have ceased. However, a complication of concussions that often goes unrecognized is post-concussive syndrome (PCS). PCS can last between a week and six months following a mild head injury and is recognized by headaches (especially during physical activity), irritability, dizziness, impaired memory and concentration, sleep disturbance, and fatigue. Treatment for PCS is usually rest and close follow up, although symptoms may persist for months. Athletes should not return to play until all symptoms, such as headaches, are resolved. Many believe that a third concussion should end an athlete’s season indefinitely to avoid serious injury to the brain.

How can head trauma be avoided?

Prevention of head injuries in contact sports is crucial because the brain cannot regenerate after injury. Coaches and athletes should maintain appropriate conditioning for participation in sports, especially focussing on the neck muscles, which when strengthened will increase the amount of force needed to cause a concussion. In addition, appropriate protective gear, especially helmets, should be worn at all time during play. Helmets should be fitted for each individual athlete and should be discarded if worn out. Medical care can be optimized if those on and off the field are able to recognize and categorize concussions and are aware of the serious implications of such head traumas.

Jordan D. Metzl, MD, the athlete’s doctor, is a nationally recognized Sports Medicine Physician at New York City’s Hospital for Special Surgery, voted the number one hospital in Orthopedics by US News and World Reports. Dr. Metzl is recognized locally and nationally for excellence in patient care, research and teaching. In addition to his practice, he is an award-winning author, a national television radio show host, a twenty five-time marathon runner and six-time Ironman triathlete. Dr. Metzl specializes in the treatment of athletics patients of all ages. Dr. Metzl is the co-founder of the Sports Medicine Institute for Young Athletes at Hospital for Special Surgery in 1999, one of the first multidisciplinary centers for the treatment and prevention of adolescent sports injury. For more, visit www.DrJordanMetzl.com.

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  • July 16, 2010

    My company treats head injuries. I just got back from the NHL Draft where the convesation regarding head injuries was to take them more serious thanks to better education for all involved.

  • June 06, 2010

    I found a heap of articles and super infomation on MomsTeam Concussion center.

  • February 19, 2010

    Thank you for posting this.

  • August 09, 2009

    i am a flyer in cheerleading so i hope th@ i never get a conncussion

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