The “Invisible” Injury: Concussions in Youth Sports

concussion in sports

It’s that time of year once again! The kids are headed back to school and fall sports will soon be in full swing.  They will be spending many hours practicing and training, anxiously awaiting the first time the lights go on or they step onto that field with their team. Rivalries abound and energy levels are high!  And of course, we hope that every athlete finishes the season successfully without any injury or incident. However, that can’t always be the way things go.  With the start of this exciting time of year just around the corner, awareness is key.  The following are some statistics from the University of Pittsburg Medical Center Sports Medicine Concussion Program:

  • Between 1.7 and 3 million sports- and recreation-related concussions happen each year. Around 300,000 are football-related.
  • 5 of 10 concussions go unreported or undetected.
  • 2 in 10 high-school athletes who play contact sports — including soccer and lacrosse — will suffer a concussion this year.
  • Girls’ soccer sees the second-most concussions of all high school sports. Girls’ basketball sees the third most.

One of the scariest pieces of information there is that as many as half of all concussions may be unreported or undetected. Sources suggest various reasons for this including that athletes may not always recognize or remember that they experienced a concussive event, or they may fear negative consequences such as a loss of playing time.

According to the CDC’s website, a concussion is a type of traumatic brain injury—or TBI—caused by a bump, blow, or jolt to the head or by a hit to the body that causes the head and brain to move rapidly back and forth. This sudden movement can cause the brain to bounce around or twist in the skull, creating chemical changes in the brain and sometimes stretching and damaging brain cells. A study published in the Journal of Athletic Training in 2017 [1] which gathered data from 147 high schools over three academic years reported common symptoms among all athletes with sport related concussions to be as follows: headache (94.7%), dizziness (74.8%), difficulty concentrating (61.0%). Other symptoms can include nausea, vomiting, sensitivity to light, loss of balance, irritability, changes in sleep patterns, vision changes, difficulty remembering, or feeling more emotional.[2]

Every concussion is serious and warrants assessment by a skilled medical professional.  And it goes without saying that an assessment cannot happen unless the athlete reports the incident or a medical professional is available to witness the event and remove the athlete from play or practice.   No athlete who has sustained a concussive injury should be allowed to return to play on the day of the injury.   After a brief period of rest during the acute phase (24–48 hours) after injury, current data supports that athletes be encouraged to become gradually and progressively more active while staying below their cognitive and physical symptom-exacerbation thresholds (ie, activity level should not bring on or worsen their symptoms). [1] Prolonged absolute rest can actually prolong recovery from a concussion.  Return to play should be directed by a trained healthcare professional. It is a graded return to activity model with specific steps needing to be successfully achieved prior to advancing to the next stage.

Every injury is different and every recovery has its own course. Some get better in days, some weeks, and some take months to years.  The majority of athletes recover and return to play within 7-28 days of their injury.[1] [3] For those people whose symptoms persist beyond the expected recovery time frames (10-14 days for adults and >4 weeks for children according to the Berlin expert consensus), data supports multidisciplinary care including but not limited to physical therapy for the cervical spine and the vestibular system.  For the athlete who is used to being healthy and active and is motivated to return to his or her sport, an active treatment program can be a very powerful part of their recovery.

The only safe number of concussions to have is zero.  With each concussion that an athlete suffers, the brain becomes more susceptible. Having a past concussion is a risk factor for having a future concussion, and having multiple past concussions is associated with having more physical, cognitive and emotional symptoms before participation in a sporting season.[3]  It is imperative for coaches and parents to encourage athletes to follow the rules of play which are designed to keep the athlete safe and also to educate athletes on the signs and symptoms of a concussion. A concussion is for the most part an “invisible” injury, so honest self-assessment of symptoms is very important.  From there, following the advice of your doctor or therapist as they help to guide you through your recovery is vital. This is not a “no pain no gain” recovery!

[1] Kathryn L. O’Connor, Melissa M. Baker, Sara L. Dalton, Thomas P. Dompier, Steven P. Broglio, and Zachary Y. Kerr (2017) Epidemiology of Sport-Related Concussions in High School Athletes: National Athletic Treatment, Injury and Outcomes Network (NATION), 2011–2012 Through 2013–2014. Journal of Athletic Training: March 2017, Vol. 52, No. 3, pp. 175-185

[2] H May, Keith & L Marshall, David & Burns, Thomas & Popoli, David & A Polikandriotis, John. (2014). Pediatric sports specific return to play guidelines following concussion. International journal of sports physical therapy. 9. 242-255.

[3] McCrory P, Meeuwisse W, Dvorak J, et al. Consensus statement on concussion in sport—the 5th international conference on concussion in sport held in Berlin, October 2016. British Journal of Sports Medicine 2017; 51:838-847.