Concussions in Sports

Concussionsin Sports

Sportshave a significant economic impact in the country earning roughly$14.3 billion per year and contribute at least 10, 000 jobs invarious sectors. Besides, it has positive health effects, which arelinked to the reduced risk of over 20 illnesses. However,participating in sports also presents significant health risks, whichif not tackled early enough, can have severe impacts on the patients(Graham, Rivara and Ford 2019). Each year an estimated 38 millionyouths participate in different types of organized sports in theUnited States. Additionally, 170 million adults take part in variousphysical activities including sports (Daneshvar et al. 1). However,many of these activities are associated with a high risk of a headinjury. A concussion is a minor brain injury, which results from ablow or bump to the head or the upper body, which causes the brain tomove rapidly inside the skull. The cerebral spinal fluid in the skullencloses the brain to protect it by absorbing shock during minorinjury. A concussion is a functional injury affecting the cognitive,affective, and physical areas that alter the way a normal brainoperates (Solomon, Johnston and Lovell 27). It is important tounderstand the issue of sports-related concussions to understand thefinancial and health burden the victims endure. The expenses onSports-related concussions accumulate to $60 billion in the UnitedStates alone (Daneshvar et al. 1).

Duringthe 1990s, the issue of sports-related concussions gained a lot ofcoverage among the sports sponsors, athletes, and sports medicalprofessionals (Powell309).Since then, the media coverage is still increasing on issues relatingto sports-related concussions and their long-term effects on theathletes. The media is keen on highlighting the incidences of damagedbrains, suicide, and dementia in retired players. The attention isgreatly needed to ensure that the players, coaches, trainers, parentsas well the public do not overlook the severity of the issue.According to research, the possibility of an athlete engaging incontact sports suffering from a brain injury is as high as 20 percentper season.

StatisticalEvidence of Sports-Related Concussions

Areport of the CDC research shows that the current number of reportedsports concussions is twice those recorded in the last ten years.“Between 1.6 and 3.8 million sports-related concussions occurs eachyear in the United States” (Broglioet al. 138).Between 2001 and 2005, young adults accounted for 2.4 millionsports-related injuries and among those six percent involved aconcussion. In 2012, 3.8 million sports-related concussions werereported, which was double the rate in 2002. Among these numbers, 33percent of the concussions occur during practice while 39 percent ofthe cumulative concussions increase the tragic head injury leading topermanent neurological disability (Broglioet al. 138).Additionally, 47 percent of all sports-related concussions occuramong young adults where one in every five athletes will sustain asports concession in one season. The situation is much worse foryouth sports because 33 percent of athletes report having moreconcussions in the same year as the first one.

Today,an approximate 5.3 million people live with traumatic brain injurydisability in the United States. Collective sports concussions havebeen proven to increase the possibility of terrible head injurycausing permanent neurological impairment by 39 percent. According tostatistics, “young athletes sustain an approximately 300,000concussions per year” (CDC1338).In 2011, the study conducted in American high schools revealed thatconcussions accounted for 15 percent of all the recordedsports-related injuries, which leads to loss at least one day of thegame (Powell309).The studies also show that the concussion rates in young athleteshave increased by 16 percent between 1997 and 2008. In 2012, a studyon several youth sports showed that concussion consisted of 13.2percent of all injuries in the games studied of which 66.6 percent ofthe injuries occurred during competitions and 33.4 percent duringpractice. According to the CDC report, between 2001 and 2009, thenumber of traumatic brain injury visits to the emergency departmentsincreased by 62 percent with the highest rates being experiencedamong young adults. The increase is possibly due to an increase inawareness and diagnosis or number of injuries (CDC1338).

Shortand Long-Term Symptoms of Concussions

Althoughmost physical contact games are prone to head injuries, some sportspose a much higher danger. Powell indicates, “The five leadingsports that account for more concussions include basketball,football, bicycling, and soccer” (307).However, concussions in football are more common for male athleteswhile female athletes suffer more concussions in soccer. Lately,there has been intensified research on the neuropathological andcognitive impacts of a concussion. Given the occurrence of headinjury in physical contact sports, the health outcomes of thiscondition may be significant. The symptoms of a concussion includenausea, headache, memory problems, fatigue, confusion, mood changes,and sleep disturbances (Caine and Purcell 157). Most of thesesymptoms and signs are easily noticed right after the injury fromminutes to hours, but some cases take days or even weeks. Contrary topopular belief, an athlete does not have to lose consciousness tosustain a concussion. Studies show that 90 percent of the concussionsdo not involve loss of perception or a disruption of mentalawareness. The athlete does not even have to hit his or her headjust a whiplash injury can result in a concussion (Pearl).

Thelong-term impacts can occur when an athlete goes back to the gamewithout allowing the brain time to heal completely. A forceful impactto the brain causes disrupts the neural membranes, which allowspotassium to flow into the extracellular space. As a result, itincreases the amino acids and calcium followed by more potassiumefflux, which leads to suppressed neuron activity. As the brain fluidbalance returns to normal, there is increased energy condition but itstill decreases cerebral blood flow hence, an individual isvulnerable to additional head injury. The diffuse cerebral swellingoccurs due to loss of regulation of the brain’s blood supply, whichcauses increased intracranial pressure and a rapid cerebral-vascularcongestion. The condition can progress to a brain stem herniation,coma, and eventually death. Caine and Purcell explain that,“resulting brain injuries can have long-term problems that canaffect the memory, sleep, balance, and mood” (158). Repetitiveconcussions can also lead to medical conditions such as movementdisorder and early Alzheimer’s disease (Solomon, Johnston andLovell 99)

Nonetheless,the most notable problem of a concussion is the second impactsyndrome. The condition occurs when a person recovering from aninitial concussion sustains a later head injury resulting in severe,permanent neurological dysfunction, diffuse brain swelling, which canlead to death (Solomon, Johnston and Lovell 15). The post-concussionsymptoms include emotional cognitive and physical problems. Thesecond impact syndrome emerges due to a concussion include memoryproblems, lack of inhibition, aggression, change in personality,language impairments, and lack of concentration. Kamberg explainsthat the second impact syndrome effects such as difficulty indecision-making, comprehending lots of information, or difficultyresolving problems can have a significant impact on an athlete’slife (19). These outcomes can make life more difficult both at workor school and in personal relationships. Fortunately, with propertreatments the symptoms improve over time.

PreventingConcussions

Fortunately, it is possible to prevent sports-related concussions by ensuringthat the athletes use properly fitted and well-maintained protectiveequipment. Secondly, the coach or athletic trainer should ensure thatevery athlete follow the stipulated safety and sports rules. “It iscritical to ensure that players, coaches, and parents are aware ofthe intrinsic dangers of concussions” (Pearl).They learn how to perform a concussion evaluation properly topreserve the athletes especially the youths’ mental ability andcognition. Accordingly, the National Federation of State High SchoolAssociations(NFSHSA)and National Collegiate Athletic Association (NCAA)hasteamed up with the CDC to educate players, coaches, parents, andschool officials on concussion recognition and management in sports(Pearl).Education helps trains all sports stakeholder on how to identify asuspected concussion. Additionally, it provides a set of rules tomanage an alleged concussion with steps to help the players return tothe game safely after healing (Kamberg 17). The NCAA and NFSHSArecommend that any athlete showing signs of a concussion should notbe involved in the sports and evaluated by a physician and then makethe appropriate decisions depending on the results (Roush 84).

Besides,sports-related concussions could be prevented in some instances usingprotective clothing. Athletes should wear certified helmets inindividual sports to protect against some head injuries such as askull fracture. However, Caine and Purcell state, “players,parents, and coaches must recognize that protective equipmentincluding mouth guards and helmets are not concussions proof”(158). Good sportsmanship, practicing fair play, and respecting therules of the sport play a significant part in reducing the risk ofhead injury.

Onthe other hand, the increased danger is associated with early returnsto the games, and emerging proof of long-term consequences ofconcussion have prompted national and state legislation for athletesparticularly for the young adults. The laws have led to new rulesdevelopment of neuropsychological testing and changing rules forsporting events (Pearl).Consequently, the concussion management practices have also changedconsiderably. Brain injuries can be difficult to distinguish due tothe complications and lack of universal definition. However, some ofthe common symptoms include headaches, dizziness, and blurry visionmakes it relatively easy to some people as long as they have learnedabout concussions. Once a player is suspected to have a concussionafter an injury, immediate first aid should be carried out to assessif the symptoms of a brain injury. Subsequently, the appropriateactions such as cognitive tests and enough rest should be undertakenbefore the player can return to the actively participate in the game.Thus, expert guidelines, clinical judgment, and accessible assessmenttools must be included to establish a clear diagnosis and estimatethe recovery time required.

ConcussionManagement

Concussionmanagement is undertaken before, during, and after the game. Duringthe pre-season preparation, it is important for the coaches orathletic trainers to know their athletes in advance prior to theseason. It ensures that the coach and the trainer the opportunity toevaluate the concussion risk factors, using a baseline concussiontesting, and provide basic guidelines to the athletes on the symptomsand signs of concussions. A baseline concussion testing is acomputer-based test on the cognitive functions to evaluate variousaspects of the brain functioning such as processing speed, memoryabilities, reaction time, and impulse control (Solomon, Johnston andLovell 50). The test is used at the onset of a sports seasons andacts as a gauge of an athlete’s healthy status. In case aconcussion occurs during the season, a concussion managementspecialist administers similar tests and compares the results tothose obtained before the injury. In case the baseline concussionevaluation was not carried out, the specialist will have to comparethe outcome after the concussion to those of the general population.Besides, testing raises awareness among players, parents, trainersand coaches ahead of the games (Pearl).At this stage, they also set up an emergency procedure protocol thatthey would follow in the case of a concussion.

“Educationis critical because studies have proven that many players do notinform the parents, trainers, and coaches of any concussion symptomsmainly because they are not aware of these symptoms” (Pearl).Therefore, educating the athletes means they will be more likely toperform self-assessment and report to the coaches when they feelsymptomatic. Most importantly, the coaches and trainers should bewell aware of the signs of concussions so that they can detect themeven if the player does not report being symptomatic. It is alsonecessary to have an Emergency Procedure Protocol before the seasonbegins to ensure that the trainers and coaches have a well-definedcourse of action to follow in the event of a suspected concussion(Niranjan and Lunsford 203). The protocol involves having an outlinedplot for activities to be undertaken in different stages ofconcussion management from the education to constant evaluation forthose recuperating from a concussion.

Ongoingconcussion management requires multi-disciplinary method owing to therisk of short and permanent impacts (Niranjan and Lunsford 203).Thus, an athlete needs support from athletic trainers, teammates,coaches, and family. However, there are controversies in concussionmanagement when an athlete has had a history of several braininjuries. Experts suggest that there is an increased risk forsubsequent head injuries following the concussion, and the injuriesmay be cumulative. In such cases, an athlete should consider retiringfrom physically aggressive sports or changing to a less risky optionto reduce the risk of recurrent head injury.

Dealingwith a Concussion

Whena suspected concussion occurs, an athlete should seek immediatemedical assistance. The player should be removed from the activityand examined by a medical professional. Afterward, the player shouldonly return to the game when the professional certifies that he orshe is fit to do so. After a brain injury, the first few days are themost critical time after a concussion. Therefore, “the injuredathlete should take a lot of rest and minimize cognitive activitiesbecause they can delay recovery or worsen the symptoms” (Caine andPurcell 155). Thus, he or she should avoid distractions through loudnoises, bright lights, as well as social activities for the first fewdays after suffering a concussion because they have a direct impacton the brain. Accordingly, it is important that the athletesundertake regular vestibular and neurocognitive testing if he or shewas very active especially in contact sports (Caine and Purcell 155).On the event of an assumed brain injury, the appropriate first-aidevaluation should be carried out, and the emergency proceduresfollowed. Then, the athlete should be examined for concussion signsand assess the athlete’ symptoms immediately after the injury.Later, a deeper analysis of his or her coordination and balance,cognitive status, and physical signs of the injury should beperformed.

Additionally,the player should not go back to the games with a suspected or knownconcussion unless with the permission of an appropriate health careprofessional. It ensures that the athlete does not suffer even worsesecond concussions before he or she has recovered. Therefore, playersand coaches are encouraged to watch out for signs of a concussion inthe field before the problem deteriorates to something unmanageable.For example, after a suspected concussion, the coach or trainershould observe if a player appears dazed, exhibits prolongedconfusion, has slowed reaction time, and loss of consciousness(Graham, Rivara and Ford 1971).

Therefore,the CDC launched a Head up Program to educate all the necessaryparticipants in the sports sector (Daneshvar et al. 1). Despite thestatistics showing that concussion is becoming an epidemic in sports,drugs for treating the condition have not been extensively studied.Nonetheless, ibuprofen or acetaminophen may decrease the duration andseverity of the symptoms particularly headaches or though there is noevidence to support this assertion. In some cases, thepharmacological agents can be used to remedy prolonged symptoms.However, it is crucial to caution the athlete against takingmedication that may ask the symptoms or signs of a concussion whenreturning to play (Pearl).If any of the symptoms reappear, the individual should have completerests until it resolves at a minimum of 48 hours before trying again.

Toolsfor Assessing Sports-Related Concussions

Thereare several medical concussion tools, which are categorized accordingto the athlete’s age. The most common tool is the Sports ConcussionAssessment Tool 3 (SCAT3), which is mainly used to evaluate athletesabove thirteen years. Another version of the SCAT3 has also beendeveloped to assess concussion in children between five to twelveyears (Graham, ‎Rivara and Ford 2041). Both tools allow for briefneuropsychological evaluation of concentration, attention, andmemory. However, the tools should not be solely used to exclude ordiagnosis of concussion in an absence of clinical judgment. The SACand SCAT3 have been validated for use in adults (Graham, ‎Rivaraand Ford 2041). “In a suspected concussion, monitoring fordeterioration should be conducted for several hours, and the athleteshould only return to the game once evaluation provides confidencethat he or she does not have a brain injury” (Pearl).

Otherassessment tools for diagnosis are the Post-Concussion Symptom Scaleand Graded Symptom Checklist. The tools are also frequently usedbecause they are affordable, easy and quick to use, with aconsiderable sensitivity level that allows the athletes to performself-report symptoms.

RiskFactors of Sports-Related Concussion

Severalrisk factors can contribute to the likelihood of having a concussion.The most notable risk is the history of prior brain injuries, whichis associated with twice a higher danger of sustaining anotherinjury. Athletes who have suffered from previous concussions may alsoshow more symptoms at the baseline. The rate of suffering from aconcussion is high if the athlete had previously sustained aconcussion (Rippe790). According to research, oncean athlete suffers from an initial concussion, the likelihood of asecond one is three to six times higher than an athlete who has neversustained a brain injury.

Thenumber, severity, and duration of the symptoms of the brain injuryare another risk factor. The symptoms indicate the gravity of thecondition, which signifies the expected recovery time (Rippe790).For instance, dizziness is at times found to be an excellentpredictor in football for recovery expected to take more than 21 dayswhole those athletes having more cognitive symptoms require morerecovery time. Hence, more severe and longer lasting symptomsindicate a more severe injury.

Genderis another determining factor of the likelihood of suffering from aconcussion. Recent studies suggest that in sports with similar rulesthe female athletes sustain more concussions as compared to the maleplayers. Besides, they report a higher number and severity ofsymptoms as well as a delayed recovery. “Some studies suggest thatfemale athletes have a higher possibility of suffering fromsports-related concussions as compared to the male athletes”(Daneshvar et al. 16). For example, the female soccer athletes areeight times more likely to suffer from concussions than male soccer.In basketball, females have higher risks of 4.5 times. Femaleathletes seem more prone to a concussion through contact with theequipment, other players, and playing surface while males suffer aconcussion from player-to-player contact (Rippe791).

Agecan also increase the chance of getting a concussion. Hence, theyouths are more susceptible to sports-related concussion and have aprolonged recovery period. The developing young brain differsphysiologically from the adult brain when comparing the blood volume,brain water content, blood flow, and blood-brain barrier. The youngbrains have less Engram and may have less cognitive reserve than moremature brains. Thus, it may account for the demonstrated increase inrecovery time for young athletes suffering from concussions(Hatzenbuehlerand Scopaz 538).

Sport,style, and position of play can also affect the risk of concussion inathletes. The most common brain injury may differ based on the sportsas well as the level of the game where the most common mechanism isthrough physical contact between players. Therefore, the sports andpositions involved in frequent collisions impacts sustain moreconcussion. Football constitutes 47 percent of the recorded sportsconcussions after which soccer and ice hockey pose most significanthead injuries (Rippe791).Lastly, a history of pre-existing migraine headaches may be a riskfactor for a concussion, which may also be associated with aprolonged recovery. A concussion can spark off a post-traumaticmigraine, which affects an athlete’s performance (Hatzenbuehlerand Scopaz 539).

(Daneshvar)

StateRegulations to Manage Concussions

Thesports industry today is characterized increased competition wherescores of athletes participate in a wide variety of high school,youth, college, recreational and professional sports (Powell307). Foryoung athletes, games provide an environment where they can grow anddevelop mentally, physically, and socially. For professional andcollege athletes, sports offer an opportunity for maintaining ahealthy lifestyle as they relieve the tensions of modern life. As thesports industry continues to thrive on a global level, thestakeholders should provide an environment that minimizes the risk ofinjury (Graham, Rivara and Ford 2041).

Therefore,it calls for proper strategies to lower the rate of brain injuries.Consequently, Washington State passed the Zackery Lystedt law in 2009to promote concussion education among athletes, coaches, and parents.The law authorizes removal from activity if a player is supposed tohave a concussion (Roush 86). Additionally, a player can only go backto the game after being cleared by a certified health careprofessional. Since then, others states have enacted similarlegislations to protect athletes and minimize the rate of concussionsin sports. Collectively, all states allows athletes particularly theyouths to return to practice or games following a concussion as soonas the treating physician has provided a written statement. It shouldexplain that in a physician’s professional judgment, it is safe forthe athlete to return to the game as well as any particular protocolthe athlete should follow to go back to the games (Roush 85).Nevertheless, the Congress can drive more action to lower theconcussion rates, by setting guidelines for managing concussions inyoung athletes.

RecoveringFrom a Concussion

Althoughthe sports-related concussions mainly focus on full contact sportssuch as ice hockey and football, concussions can happen across abroad range of sports (Powell307).The concussion rates differ by gender sports and type of exposureduring the games. An understanding of the concussion rates, riskfactors, and patterns of injury can drive targeted preventivemeasures to help decrease the risk for concussion in all sports. Therecovery times varies depending on the athlete’s health, the extentof the injury and the rate of medical attention. In more than 50percent of young athletes, the post-concussion symptoms cleared inthree days while 50 percent of the athletes returned to activeparticipation in the games in nine days. However, 30 percent of theplayers who have sustained a concussion still experience signs andsymptoms three months after the injury while one in seven is stillsymptomatic even after one year.

Luckily,most athletes recover from most concussions and other mild traumaticbrain injuries within six weeks (Petraglia, Bailes, and Day 181).However, some people experience post-concussion syndrome withsymptoms lasting longer than the estimated six weeks althoughlong-term effects of concussions are very rare. The impacts of aconcussion depend on the size and location of the injury butgenerally, they have similar symptoms that make it possible to detectthe problem early enough for appropriate actions. However, it isnecessary to have a periodic evaluation of the patient to determineany behavioral, cognitive, and emotional and language challenges theymay be facing due to the injury (Petraglia, Bailes, and Day 1822).

FutureResearch

Emergencydepartment records more than one million visits every year fortraumatic brain injuries, a majority of which is concussions. Thenagain, the statistics may be underreported because a considerablenumber of athletes do not get adequate medical care for headinjuries. It is also necessary to have better researcher and evidenceto explain the reasons for gender differences in concussions.Currently, there is minimal research on why the female athletes areso susceptible to sports-related concussions and how to reduce theserates considerably. For example, in boys’ lacrosse, it is mandatoryto have helmets, but the case is not the same for the girls’ teams.Without research and conclusive evidence, the assumptions range onwhether helmets would make the female athletes less vulnerable toconcussions or just encourage them to be more aggressive on the fieldrendering them even more exposed. Hence, there are many possibleexplanations for why female athletes experience higher rates ofconcussions.

Thenagain, the reason behind gender differences such higher concussionrates in similar sports may be that the athletic trainers are betterable to identify the subtle signs of concussion and handle thecondition before it becomes unmanageable. Besides, some of the maleathletes may be reluctant to report concussions for fear of losingtheir spot in the game, which may result in underestimation ofincidences of concussion among boys (Snyder).On the other hand, the female athletes may be honest when reporting aconcussion, which results in a greater portion of girls’ concussionbeing diagnosed and documented thus showing higher rates (Kamberg17). A third explanation to determine the reason for the genderdifference in concussion may be due to hormonal factors such as theprotective effect of estrogen present in males, which significantlyreduces the rate of concussions. As the symptoms improve, the athletecan gradually increase social activities and cognitive tasks as longas the symptoms are not aggravated (Snyder).

Therefore,until the further research can provide sound recommendations forpreventing and managing concussions, the care of injured athletesfalls directly on the clinicians. Hence, it is crucial for medicalprofessionals to continue to keep in line with the modern advances tounderstand more about concussions (Snyder).

Conclusion

Sports-relatedconcussions and head injuries are quickly gaining a lot of publicity.Lack of early diagnosis and treatment of a concussion can result inserious long-term consequences, which may even prove fatal. While thefirst concussion is challenging, the second or third head injury cancause more severe and long-term brain damage. A concussion can occurin any sports, but those athletes participating in contact sports areat a higher risk. The sports-related concussions range between 1.6and 3.8 million every year in the United States, which leads the CDCto conclude that sports concussion in the country has reached anepidemic level. The most worrying trend for young athletes is asecond impact concussion before the brain fully recovers. The issueof concussion is made worse by the fact that any athletic trainers,coaches, and sports medicals professions do not utilize thestipulated guidelines correctly for concussion assessment andmanagement. It may be difficult or even impossible to eliminateconcussion from sports. However, with better information, the majorstakeholders in the sector will attain an enhanced understanding ofthe type of activities and actions that result in concussions.Besides, the knowledge can facilitate the development of improvedtechniques for handling concussions and changes in sports rules tominimize the rate and severity of the injuries. The trainers andcoaches have a crucial role in reducing the incidence of traumatichead injuries. They must ensure that all the players learn andpractice proper sports techniques such as tackling in football, bodychecking in hockey and heading in soccer. They should also promote anatmosphere of fair play, respect, and good sportsmanship amongathletes. Enforcing sports rules also helps to reduce the incidenceand risk of concussion. Sports are an incredible growth opportunity,worthwhile recreational activity, and career. Thus, it is rewardingto keep playing, but one should play safely.

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