Usually the sports medicine staff will make the diagnosis of the concussion on the sideline. It is hopeful that if an athlete has his or her “bell rung” that the coaching staff will pull the athlete off the field immediately for evaluation. It is strongly recommended that any athlete showing signs or symptoms of concussion be evaluated by a trained sports medicine specialist and that the athlete NOT return to the event. There used to be a rule that if an athlete appeared to have a slight “Bell Ringer” that he could return to the game after a half hour of observation if no worsening of symptoms. This rule should not be practiced anymore due to findings that the symptoms may worsen with time over minutes to hours and repeated head blows could cause further brain injury.

The old guidelines for diagnosis and treatment of concussions have been replaced by new standards put in practice by several sports & neurological medicine societies in 2001 and updated in 2004. The old guidelines use to have set amount of weeks that an athlete would have to sit out of sports, based on the number of concussions sustained during a season. These old guidelines also used to grade concussions as mild, moderate or severe based on certain signs & symptoms at the time of concussion injury.

The new Vienna-Prague guidelines have graded concussions as simple or complex based on symptoms an athlete displays over time. (days to weeks) Both types of concussions are deemed serious and no player should return to their sport until all symptoms have resolved totally. Simple concussion symptoms usually resolve after a few days and return to play is within a 1-2 week time frame. Complex concussion symptoms last from weeks to months. These types of concussions are critical and the athlete could suffer long lasting memory and learning disabilities. Return to contact sports after suffering a complex concussion could take up to 3 weeks to possibly never being able to play contact sports ever again.

When an athlete sustains a concussion he should be evaluated at the onset and observed by sports medicine staff for any worsening symptoms. If this happens the athlete should be transported to the emergency room for immediate evaluation to rule out other brain trauma such as a brain bleed. If the athlete is stable and improves he should be taken home by a parent or other responsible guardian. The parent should be given information on the head injury and advised to check the athlete several times during the next 24-48 hours. If any signs of mental status changes such as increased confusion, decreased alertness, nausea & vomiting or seizure the athlete should be taken to the emergency room.

All concussions should be evaluated within 3-4 days by primary sports medicine specialist or a physician trained in head trauma injuries. The examination consists of a full neurological history and physical exam. The duration of amnesia and current post-concussive symptoms usually will give the physician an idea of how long it will take for recovery. The physician may have to see the athlete every 5-7 days based on symptoms. The physician may order further testing such as MRI or neuropsychological testing if symptoms persist for greater than 5-7 days. The athlete could be prescribed a non-aspirin based medicine for headache such as acetaminophen (Tylenol). Often a concussed athlete may be held from school for several days due to increased headache and other symptoms that are brought on by memory taxing school work. A regimen of total rest may be needed for recovery.

Once the athlete has recovered from the post concussion symptoms, he or she will be placed in a return to play protocol. The protocol is a stepwise progression of daily activities. If post concussive symptoms reoccur with the protocol, the athlete is held out until these symptoms fully resolve. The protocol: DAY 1 – Light aerobic exercise (bike, jog, swim)
DAY 2 – Sports-specific training (running, kicking, catching, agilities)
DAY 3 – Non-contact drills
DAY 4 – Full contact after medical clearance
DAY 5 – Game

It is difficult to fully prevent concussions from happening in sports. Proper fitted equipment (helmets) has been shown to aid in concussion prevention. Mouth guards have not yet shown to prevent concussions. Proper tackling technique and rule changes (spearing) has decreased the incidence of concussion. Neck and shoulder strength can help the body to reduce head impact and possibly reduce severity of concussions.

Recent concussion research has proven that these head injuries should not be taken lightly. Concussions can lead to severe neurological impairment, depression & permanent disability. Coaches, parents and athletes should learn the signs & symptoms of concussions. Coaches and parents are around their student-athletes for long periods of time, and it is imperative that these injuries are not ignored. Sometimes the obsessive “Win at all costs” attitude clouds people’s proper judgment. I hope that the COST of winning does not cost a young athlete his or her health and well-being for the rest of their life.

Any questions or if an athlete needs evaluated for a concussion, please contact:
James Goff, D.O., at (330) 837-9294 for an immediate appointment.

Dr. Goff’s office is located in the Mercy/Jackson Medical facility.
7452 Fulton Rd. NW Massillon, Ohio 44646