“He’s concussed … again.” I remember my mom, scared and in disbelief, uttering those sobering words to me my junior year in college. A helmet-to-helmet hit resulted in my brother Christian’s third concussion, ending his high school football career at the ripe old age of 15. The following year, a fourth concussion from a rowing accident rendered him nearly bedridden.
While the severity of post-concussion syndrome that Christian experienced is rare, there are still 200,000 concussion-related emergency room visits in the U.S. each year, according to the Centers for Disease Control. Classified as a traumatic brain injury (TBI), concussions can have serious effects no matter the severity of the hit.
“There’s no concussion pill,” says Dr. Julian Bailes, the Chairman of the Department of Neurosurgery and Co-Director of the NorthShore Neurological Institute. The doctor, portrayed by Alec Baldwin in the new movie “Concussion” (in theaters Dec. 25), explains that there is no quick route to healing this kind of injury. Recognizing symptoms and understanding treatment options can help prevent further injury to the already-inflamed brain.
Symptoms of a Concussion
Whether your child receives a serious hit or slight bump to the head, symptoms of a concussion should not be ignored.
“Anytime I have an inkling a player may have a concussion, I have the parents come over — I don’t wait,” says John Trkla, head coach of the School of St. Mary football team. “I have [injured players] follow my finger with their eyes and ask them simple questions such as ‘what month comes after March?’”
Kelly Trainor, APN, NP, of the Lurie Children’s Memorial Hospital Sports Medicine Team, notes that symptoms fall under four different categories:
- Physical (headache, nausea, dizziness, light/noise sensitivity)
- Cognitive (feeling “foggy,” memory issues, concentration difficulties)
- Emotional (increased irritability, anxiety, sadness)
- Sleep (drowsiness/fatigue, sleeping more or less than usual, difficulty falling asleep)
Trainor adds that not everyone will experience every symptom or even every category. “No two concussions are alike, so [the symptoms from] one concussion may be different than another, even within the same individual.”
Risks of Having a Concussion
Contrary to popular belief, concussions are not solely caused by blows to the head. Any action that causes the head to snap back violently (the jerking of the neck from a forceful tackle) can likewise cause the brain to slide violently back and forth against the inside of the skull. That sliding motion may damage brain cells and cause chemical changes in the brain.
“Most concussions are mild, which means they resolve within a week,” notes Bailes. However, with more severe concussions, the symptoms displayed in the short-term may turn into chronic problems.
“We don’t really know why some have post-concussion syndrome while others don’t,” explains Bailes. “It also probably depends on many factors related to the concussion, including the number, their sport, and perhaps there is some genetic susceptibility.”
Pushing a player to return to school or a sport too soon can lengthen his or her recovery time. Trainor’s team, headed by Dr. Cynthia Labella, has worked closely with Senator Kwame Raoul in rewriting Illinois legislation regarding youth concussions.
“The new legislation requires Return to Learn and Return to Play protocols to be implemented in all Illinois schools,” explains Trainor. “This is beneficial because it will allow for safer return to activity guidelines, keeping children with active concussions from returning to sports or schoolwork too soon.”
Recovery, however, does not signal the end of concussion-related risks. “Anyone who has had a concussion is somewhat more likely to get another, and I think that applies to adults as well as children,” says Bailes. “I suppose it’s the sport that they participate in, their style of play and other factors.”
Sometimes, a recovered player may lose the confidence he or she once had on the field or court. “I do see that trepidation after serious hits,” recalls Trkla. “They’re scared of it happening again.”
How to Properly Treat a Concussion
Immediately following a suspected concussion, the player should be removed from play. “If the patient is unconscious or motionless, do not move or take off athletic equipment; call 911,” advises Trainor.
The following week should include downtime and staying out of harm’s way. “Rest is key; this includes both cognitive and physical rest until the patient is feeling better,” says Trainor.
When a concussed individual experiences a prolonged recovery, the medical team may suggest a variety of therapies. Trainor recommends physical therapy for “sub-symptom threshold aerobic exercise training” and for those experiencing “persistent neck strain” and vestibular therapy for those displaying “persistent balance problems, dizziness or visual deficits.” When patients experience persistent cognitive deficits, Trainor recommends occupational therapy to address these memory deficits. Sometimes patients will display a need for continued academic accommodations. In this case, patients may undergo formal neurocognitive evaluation and testing to receive the accommodations in school.
Often, the strain of a prolonged recovery may significantly impact a patient’s disposition and ability to cope. Therapy with a psychologist is recommended by Trainor’s team to help with coping and stress management.
Outside of therapies, Bailes has offered an interesting dietary approach to treatment — fatty acids such as Omega-3s. “We think that O-3 may play a role to reduce inflammation and have both a preventative and healing effect [on the brain].”
Returning to Sports
When Christian had his first concussion, he missed a significant amount of seventh grade. However, he felt more removed from his peers when he was told he might not be allowed to play football again. The debates over whether to let him return ensued between parents and son. Even with the third concussion, the athletic kid with a heart the size of a football did not retire quietly.
“There are a lot of factors to consider when evaluating clearance and making return-to-play decisions,” says Trainor. “How many concussions to date, how long is each recovery, is it taking less force to cause injury, are there any permanent deficits or persistent findings, does the child have underlying conditions that could be exacerbated by another head injury [all contribute to such evaluation].”
“Once a child is deemed appropriate for clearance [to return to the sport] by the medical team, it then becomes a family decision,” adds Trainor.
“That’s always going to be a hard question,” reflects Trkla. “To me, there’s always going to be a risk of concussion [in the sport]. It just goes down to the kid’s passion to play. How badly do you want to play this sport?”