So, I’m on hold again, with the physician’s office. Just enough time to write a blog post. Our daughter, Bella, has been to about 100 medical visits this year due to a sports-related concussion.
In Bella’s case, she sustained a sheer force rotational injury when a teammate fell on her head. Her vestibular, visual and cognitive symptoms were severe for 16 weeks, the first 12 of which she did not smile, not once. As her mom, I felt like we’d lost the energetic girl we knew. She was quiet, sleepless, dizzy and in constant pain.
We are now 9 months out, and her attention and memory are about 80% of what they were and she is finally able to study sufficiently to get back to her regular A’s and B’s in high school. She will not go back to her previous sport but will be able to do non-impact sports vigorously within the year.
There are so many things I wish I had known at the outset, here is the landscape of knowledge, you may wish to have.
1. How common are concussions?
- In 2017, an estimated 2.5 million high school students reported having at least one concussion related to sports or physical activity during the year preceding the YRBS, and an estimated 1.0 million students reported having two or more concussions during the same time frame. The findings suggest that students who played on a sports team had a significantly higher risk for one or more concussions than did students who did not play on a team. Furthermore, concussions were significantly more common among students who played on two and three or more sports teams than among those who played on one team.
- The prevalence of having one or more concussions (15.1%) is comparable to the findings of an analysis of 2013 YRBS data from three states that added different questions to their survey to assess sports-related concussions among high school athletes. In that study, the prevalence ranged from 17.6% to 20.1% (4).
- The prevalence of concussions in the current study is higher than estimates based on emergency department data (e.g., 622.5 visits per 100,000 population aged 10–14 years) (5) and athletic trainer reports (e.g., 1.8 per 100 high school and college athletes for an average season) (6). Emergency department data miss concussions treated elsewhere, and athletic trainer reports miss concussions sustained outside of school-based sports; both sources miss medically untreated concussions (2).
2. How common are sports-related concussions?
According to the University of Pittsburgh’s Brain Trauma Research Center, more than 300,000 sports-related concussions occur annually in the U.S., and the likelihood of suffering a concussion while playing a contact sport is estimated to be as high as 19 percent per year of play. More than 62,000 concussions are sustained each year in high school contact sports, and among college football players, 34 percent have had one concussion, and 20 percent have endured multiple concussions.
According to CDC estimates, 1.6-3.8 m sports and recreation-related concussions occur each year in the U.S. 10% of all contact sport athletes sustain concussions yearly. Brain injuries cause more deaths than any other sports injury. In football, brain injuries account for 65% to 95% of all fatalities.
Estimates show that between four and 20 percent of college and high school football players will sustain a brain injury over the course of one season. The risk of concussion in football is three to six times higher in players who have had a previous concussion. Source: Amer Assoc Neurological Surgeons
3. What sports result in the most concussions?
- 47% of all reported sports concussions occur during high school football
- Rates per per 100,000 athletic exposures
- Football: 64 -76.8
- Boys’ ice hockey: 54
- Girl’s soccer: 33
- Boys’ lacrosse: 40 – 46.6
- Girls’ lacrosse: 31 – 35
- Boys’ soccer: 19 – 19.2
- Boys’ wrestling: 22 – 23.9
- Girls’ basketball: 18.6 – 21
- Girls’ softball: 16 – 16.3
- Boys’ basketball: 16 – 21.2
- Girls’ field hockey: 22 – 24.9
- Cheerleading: 11.5 to 14
- Girls’ volleyball: 6 – 8.6
- Boys’ baseball: Between 4.6 – 5
- Girls’ gymnastics: 7
4. Loss of consciousness is not common.
- 90% of most diagnosed concussions do not involve a loss of consciousness.
5. There is no universally accepted definition of concussion.
A concussion is a type of traumatic brain injury that occurs when a head impact jars or shakes the brain inside the skull. The brain is a soft organ surrounded by spinal fluid that acts like a cushion during normal movement. If the head or body receives a significant hit, the brain may crash into the skull and sustain injury. Delicate neural pathways in the brain can become damaged, causing neurological disturbances. Cervical disruption and inflammation can extend recovery time.
A traumatic brain injury or concussion can be caused by a fall, injury or a blow to the head. Common causes of concussions include car crashes, bike accidents, and fights. Concussions can also occur while participating in sports such as soccer, football, skiing, boxing, hockey and more. Most bumps on the head are minor and heal just like bumps anywhere else on the body. However, sometimes a head impact can be worse than it looks. Even if there is no bleeding or visible bump, head trauma can cause complications such as dizziness, headache, loss of balance or a loss of consciousness.
6. Concussions result in a broad range of symptoms that vary from person to person based not only on the type of injury sustained but also the pre-existing condition of the athlete.
7. The more severe warning signs can be seen across cognitive, motor and speech domains.
- Pain: Constant or recurring headache
- Motor dysfunction: Inability to control or coordinate motor functions, or disturbance with balance
- Sensory: Changes in the ability to hear, taste or see; dizziness; hypersensitivity to light or sound
- Cognitive: Shortened attention span; easily distracted; overstimulated by the environment; difficulty staying focused on a task, following directions or understanding information; feeling of disorientation, confusion, and other neuropsychological deficiencies.
- Speech: Difficulty finding the “right” word; difficulty expressing words or thoughts; stammering or stuttering.
8. Cognitive symptoms can be related to axonal shearing, pain, and inflammation. To me, this is really important because what looked like permanent grey matter damage was more likely, cervical and axonal damage that was impacting Bella’s cognitive function.
Many physicians have the concussion protocol down and early state treatment is helpful. Yet, for many students, longer-term care is needed. Understanding the signs, symptoms, and treatment options is important for parents.
Dr. Lynne Kenney is the nation’s leading pediatric psychologist in the development of cognitive-physical activity programs for students K-6. Dr. Kenney develops curriculum, programming, and activities to improve children’s cognition through coordinative cognitive-motor movement, executive function skill-building strategies, and social-emotional learning.