Sport-Related Concussion I: Injury Prevention and Initial Assessment

Philip H. Montenigro, Daniella C. Sisniega, and Robert C. Cantu

GENERAL RECOMMENDATIONS FOR PREVENTION AND MANAGEMENT OF SPORT-RELATED CONCUSSIONS

Treating or reducing the effects of a concussion can be challenging; therefore, prevention is an important strategy for dealing with concussion. The following are recommended by the Expert Consensus Document of the Safe Sports Think Tank: Exploring the relationship between childhood sport-related concussions and long-term cognitive outcomes conference [1], and the National Center for Catastrophic Sports Injury Research (NCCSI) [2,3]:

• Middle school and high school athletes should be required to undergo a physical examination and baseline testing before the start of the season. Athletes should also be educated on the symptoms of concussion and urged to report any symptoms that they may experience throughout the course of the sports season.

• All teams should have a qualified coach that is trained in physical conditioning, skills and rules of their sports, and risk of injury for their athletes.

• Helmets and proper safety equipment should always be worn and be appropriately fitted. There is no evidence that validates the efficacy of helmets in the prevention of concussions; however, helmets have been shown to reduce catastrophic injuries [2].

• Proper protocols should be followed to ensure the safety of training facilities, equipment maintenance, and the availability of written emergency procedures.

• Game officials must strictly enforce rules and coaches should support efforts made to ensure safe competitions.

• Fair play and respect should be supported as key elements of the sport, and violence should be discouraged.

Concussions are one of the most complex injuries to diagnose, assess, and manage in sports medicine. It is important to note that the symptoms of a concussion may not be immediately apparent and may not first come to attention until hours after the injury [1]. Currently, there is no perfect diagnostic test or marker for the immediate diagnosis of concussion. It is generally accepted that the more tools used to assess concussion the better the recognition.

The following are recommendations for the proper management of a suspected concussion (see Chapter 10 for a detailed discussion of management of sport-related concussion):

• If an athlete exhibits the symptoms of concussion they should be removed from play, evaluated by a member of the medical team, and monitored for deterioration.

• Sideline evaluations should be based on the recognition of potential injury, mechanism of injury, and assessment of symptoms and signs, including cognitive function, and cranial nerve function, especially eye tracking and balance.

• The Sport Concussion Assessment Tool 3 (SCAT3) [4], Child Sport Concussion Assessment Tool 3 (Child SCAT3), Standardized Assessment of Concussion (SAC) [5], or similar evaluation should be used for formal assessment of concussive injury. Standard orientation questions, such as person, place, and time, have not been demonstrated as being an effective assessment tool.

• Most concussions occur without loss of consciousness and many without immediately apparent neurological signs. Therefore, athletes should continue to be monitored for deterioration for a few hours after the injury.

• Athletes diagnosed with a concussion should not be allowed to return to play on the day of the injury.

• Additional tools to prevent concussion include incorporating neck strengthening into fitness and conditioning programs, and learning proper techniques for bracing for impact [6,7]. Both of these approaches may help to reduce head acceleration as they increase effective mass (Force = Mass × Acceleration). Effectively, if the head is stabilized during an impact, the center of gravity shifts to include the mass of the body, thereby reducing the effect on the head. This is especially true for youth and women, who have weaker necks.

• Education that provides athletes an awareness of concussion risks and how altered behavior can reduce those risks is of importance as well.

SPORT-SPECIFIC RECOMMENDATIONS

American football is the sport associated with the greatest number of concussions in the United States, with 42.7% of high school football players reporting at least one concussion and 34.9% reporting multiple concussions [8]. Most concussions are a result of tackling, being tackled, and helmet-to-helmet impact at the top-front of the helmet [7,8]. Research has shown that offensive linemen have the highest number of undiagnosed concussions and should therefore take additional precautions [9]. Recommendations for football include:

• Athletes younger than 14 (and particularly those younger than 12) years old should play flag football and not full contact tackle [10].

• Helmet-to-helmet impact, butt blocking, face tackling, and other techniques in which the helmet and facemask purposely receive the brunt of the initial impact should be discouraged in both practice and games.

• Players should avoid using their heads as battering rams when blocking, tackling, and ball carrying and keep their heads and faces out of blocking and tackling.

• Ball carriers should not lower their heads when making contact with the tackler.

• Ideally, helmets should be designed to protect the head from impact of up to 10 m/sec, reduce linear acceleration to below 50 g, and angular acceleration to below 1,500 rads/sec² [11]. This is not possible with current materials and technology.

• The rules prohibiting spearing should be enforced in practice and games. All coaches, physicians, and trainers should take special care to see that the players’ equipment, particularly the helmet, is properly fitted [12].

• Coaches should severely limit or remove full contact from practice [13].

• Any player with concussion symptoms should be examined by a member of the medical team and not be allowed to return to play until symptoms resolve.

Only gold members can continue reading. Log In or Register to continue