Despite a vast increase in volume in published research over the past five years, sports-related concussion has remained one of the most controversial and debated issues within the field of sports medicine. Concussions are probably also one of the least understood sports injuries by the general public including the athletes themselves, coaches, parents and relatives.
What is a concussion?
There are many different definitions of what a concussion is. There have been several international conferences over the years where many different types of medical providers, such as doctors, therapists, professional coaches etc. have gotten together to not only define what a concussion is, but also to try and describe the signs and symptoms; grade the severity; come up with diagnostic and treatment options; as well as return to play criteria.
One of the more common international statements on sports related concussions took place in Prague in 2004. A paper that was published in the Clinical Journal of Sports Medicine (Volume 15, No. 2, March 2005, pages 48-55) can act as a detailed reference source on this subject if anyone wants to read further on this subject. The Prague conference defined a sports concussion as “...a complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces. Several common features that incorporate clinical, pathologic, and biomechanical injury constructs that may be utilized in defining the nature of a concussive head injury include:
€ Concussion may be caused either by a direct blow to the head, face, neck, or elsewhere on the body with an “impulsive” force transmitted to the head.
€ Concussion typically results in the rapid onset of short lived impairment of neurologic function that resolves spontaneously.
€ Concussion may result in neuropathological changes but the acute clinical symptoms largely reflect a functional disturbance rather than a structural injury.
€ Concussion results in a graded set of clinical syndromes that may or may not involve loss of consciousness. Resolution of clinical and cognitive symptoms typically follows a sequential course.
€ Concussion is typically associated with grossly normal structural neural imaging studies.
What does all this mean in “layman terms?”
Basically a concussion is a brain injury that can be caused by either a direct or indirect blow, where a force is transmitted to the athlete's head and subsequently the brain itself. It usually results in a rapid onset of dysfunction that is usually, but not always, short lived and usually, but not always, resolved spontaneously. The vast, vast majority of time there is no obvious structural abnormality that can be seen or evaluated by current diagnostic studies such as CT scan or MRI scan. It is more of a functional/ “chemical” type of abnormality within the brain. There is a lot of research going on looking at other types of diagnostic studies that may be able to define and pick up a concussion, but currently there are no specific X-rays CT scans or MRI to definitively “show a concussion.” In other words, the reason why a CT scan or MRI is often ordered is to rule out a structural abnormality such as a blood clot, a bleed, or some actual structural damage to the brain. The Hallmark of a concussion is that these studies are usually negative. The fact that they are negative does not necessarily mean that the person does not have a concussion, it usually only further reinforces it.
Concussions are usually graded according to severity. There are many different grading systems, the most common usually grade the concussion as Grade I (mild), Grade II (moderate), Grade III (severe). I will discuss the grading system in more detail later on.
Concussions also usually result in a specific set of findings that can be observed and evaluated by medical personal, athletic trainers, and also by trained coaches, athletes and parents.
What are some of the more common symptoms?
One of the most common is a headache. Other symptoms include “pressure in the head,” neck pain, balance problems or dizziness, nausea or vomiting, vision problems, hearing problems/ringing in the ears, “I do not feel right,” feeling “dinged” or “dazed,” confusion, feeling slowed down, feeling like “in a fog,” drowsiness, fatigue or low energy, more emotional than usual, irritability, difficulty concentrating, difficulty remembering, sometimes things such as “sadness,” nervousness or anxiousness, trouble falling asleep, sleeping more than usual, sensitivity to light, sensitivity to noise, as well as other symptoms are things that can occur with a concussion.
These symptoms are typically called “post concussive signs and symptoms.” Amnesia either before or after the event is also not an uncommon finding with a concussion. Loss of consciousness is something that is not uncommonly seen either.
Next month, I will continue to explain the different grades of concussions and the guidelines on getting a player back in the game after recovering from this injury.
Dr. Marc P. Pietropaoli is a board certified/fellowship trained
orthopedic surgeon/sports medicine specialist and is president of Victory Sports Medicine & Orthopedics in Skaneateles.
There are many different definitions of what a concussion is. There have been several international conferences over the years where many different types of medical providers, such as doctors, therapists, professional coaches etc. have gotten together to not only define what a concussion is, but also to try and describe the signs and symptoms; grade the severity; come up with diagnostic and treatment options; as well as return to play criteria.
One of the more common international statements on sports related concussions took place in Prague in 2004. A paper that was published in the Clinical Journal of Sports Medicine (Volume 15, No. 2, March 2005, pages 48-55) can act as a detailed reference source on this subject if anyone wants to read further on this subject. The Prague conference defined a sports concussion as “...a complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces. Several common features that incorporate clinical, pathologic, and biomechanical injury constructs that may be utilized in defining the nature of a concussive head injury include:
€ Concussion may be caused either by a direct blow to the head, face, neck, or elsewhere on the body with an “impulsive” force transmitted to the head.
€ Concussion typically results in the rapid onset of short lived impairment of neurologic function that resolves spontaneously.
€ Concussion may result in neuropathological changes but the acute clinical symptoms largely reflect a functional disturbance rather than a structural injury.
€ Concussion results in a graded set of clinical syndromes that may or may not involve loss of consciousness. Resolution of clinical and cognitive symptoms typically follows a sequential course.
€ Concussion is typically associated with grossly normal structural neural imaging studies.
What does all this mean in “layman terms?”
Basically a concussion is a brain injury that can be caused by either a direct or indirect blow, where a force is transmitted to the athlete's head and subsequently the brain itself. It usually results in a rapid onset of dysfunction that is usually, but not always, short lived and usually, but not always, resolved spontaneously. The vast, vast majority of time there is no obvious structural abnormality that can be seen or evaluated by current diagnostic studies such as CT scan or MRI scan. It is more of a functional/ “chemical” type of abnormality within the brain. There is a lot of research going on looking at other types of diagnostic studies that may be able to define and pick up a concussion, but currently there are no specific X-rays CT scans or MRI to definitively “show a concussion.” In other words, the reason why a CT scan or MRI is often ordered is to rule out a structural abnormality such as a blood clot, a bleed, or some actual structural damage to the brain. The Hallmark of a concussion is that these studies are usually negative. The fact that they are negative does not necessarily mean that the person does not have a concussion, it usually only further reinforces it.
Concussions are usually graded according to severity. There are many different grading systems, the most common usually grade the concussion as Grade I (mild), Grade II (moderate), Grade III (severe). I will discuss the grading system in more detail later on.
Concussions also usually result in a specific set of findings that can be observed and evaluated by medical personal, athletic trainers, and also by trained coaches, athletes and parents.
What are some of the more common symptoms?
One of the most common is a headache. Other symptoms include “pressure in the head,” neck pain, balance problems or dizziness, nausea or vomiting, vision problems, hearing problems/ringing in the ears, “I do not feel right,” feeling “dinged” or “dazed,” confusion, feeling slowed down, feeling like “in a fog,” drowsiness, fatigue or low energy, more emotional than usual, irritability, difficulty concentrating, difficulty remembering, sometimes things such as “sadness,” nervousness or anxiousness, trouble falling asleep, sleeping more than usual, sensitivity to light, sensitivity to noise, as well as other symptoms are things that can occur with a concussion.
These symptoms are typically called “post concussive signs and symptoms.” Amnesia either before or after the event is also not an uncommon finding with a concussion. Loss of consciousness is something that is not uncommonly seen either.
Next month, I will continue to explain the different grades of concussions and the guidelines on getting a player back in the game after recovering from this injury.
Dr. Marc P. Pietropaoli is a board certified/fellowship trained
orthopedic surgeon/sports medicine specialist and is president of Victory Sports Medicine & Orthopedics in Skaneateles.
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cm wrote on Sep 11, 2007 1:04 PM: