What is a concussion? To simplify a concussion is a brain injury, a mild traumatic brain injury (mTBI). The 4th International conference of Concussion in Sport, which met at the FIFA headquarters in Zurich this past November, defined it further.
“A complex pathophysiological process affecting the brain, induced by biomechanical forces…”
They went on further to explain them with four points
So what does all that mean? Let me try to help you make sense of it all.
Concussion is a brain injury that affects brain function. Concussion can be caused by anything that forces the brain to rebound inside the skull. It does not have to be a direct blow to the head by another player, the ground, a goal post, a hard shot, or even getting hit in the body can also cause concussion. Signs and symptoms can occur rapidly and have a sudden onset, however, it is not atypical to find signs and symptoms occurring well after the event. Concussions typically do not affect the physical structure of the brain, but the function of the brain. This is why when an athlete suffers a concussion the CT scan and or MRI may come back negative. Those tests are looking for structural deficiencies. In order to suffer from a concussion the athlete does not have to have lost consciousness. In fact, a majority of athletes who suffer from concussions never lose consciousness.
So your athlete sustains a concussion. What happens next?
First and foremost athletes need to be honest with themselves and the coaches when things are not right. Athlete will hide their symptoms in order to stay in the game. This is not a good idea because it increases the likelihood of the symptoms becoming more severe and increasing the chances of death due Second Impact Syndrome. Once the athlete has sustained a concussion he/she needs to be evaluated by the medical professional that knows how to deal with concussions. Athletic trainers are the first resource on the sidelines in this area. They are present at a vast majority of the high school sporting events in the area.
During the evaluation the athletic trainer will go over a list of 22 symptoms and the athletes’ rating of their severity. This is called the Graded Symptom Checklist. This is important because it allows the athletic trainer to get an objective view of the concussion and determine a course of action. The checklist also will allow the athletic trainer to monitor the recover of the athlete by noting a resolution of symptoms and severity. Remember there is no such thing as a mild concussion anymore.
Once it is determined that athlete has a concussion that athlete will be removed from the practice and/ or the game. This is the policy MSHSAA has implemented as well as the agreed upon decisions of the Zurich conference. The athlete will be monitored throughout the continuation of the game. The athlete should be referred to a physician that is up-to-date on concussion protocols and training. This is not the ER unless symptoms dictate. The athletic trainer should give a copy of the symptom checklist to the family to take with them to the physician.
Return to play
One of the first questions from any athlete following an injury is when can they go back to competition. The answer is always well that depends. Each concussion is different just as each athlete is different. How the athlete treats his/her recovery will play a big part. The first thing an athlete needs to be is symptom free for 24 hours. In order to achieve this the athlete needs to have complete cognitive rest. This includes watching TV, texting driving, homework, or anything that involves cognitive function. Just as you would rest an ankle sprain or a knee injury the brain needs to recover appropriately and that means complete cognitive rest without medication or drugs.
Once a concussed athlete has been symptom free for 24 hours they will be allowed to begin the graduated return to play protocol, RTP. This starts with easy aerobic work. Each step is 24 hours long. If there is no return of symptoms with each step the athlete will be allowed to proceed to the neck step. This is usually a 7-10 day process but it can be longer. MSHSAA standards as well as local polices will require the athlete to be symptom free for 7 days prior to returning to competition. The RTP protocol will increase from easy aerobic activity to sprints, changing directions, lifting weights, to non-contact drills, to full contact practices. The athletic trainer will modify each step for the athlete’s specific sport.
An athletic trainer is a medical professional that has obtained his or her degree in athletic training and has is certified by the Board of Certification, a national governing body. In the state of Missouri all athletic trainers must be licensed to practice. They are trained in the prevention, diagnosis, and intervention of emergency, acute, and chronic medical conditions involving impairment, functional limitations, and disabilities.
Andy has been a certified athletic trainer since 2007 when he graduated from Missouri State University. He went on to get his Master’s degree from Emporia State University in Emporia, Kansas. Andy has been working in the secondary school setting since 2008. During that time he has been a part of implementing policies and procedures. Through research and continuing education, he has been able to help put together policies that athletic trainers can use to treat concussions.
Andy’s began playing soccer when he was 5. He played for Firestorm SC in Southwest Missouri. During high school he played goalkeeper for Neosho High School from 1999-2003. Andy began refereeing in 1997. He has progressed to a State 5 referee, participating in the Midwest Regional tournament for 5 years, attending the ODP national Championships in 2010. When the Women’s Professional Soccer league was in St. Louis he was on the list of referees. Along with being a USSF referee Andy is also a MSHSAA referee and a college official.