Concussions, Part 1: Do We Have It All Figured Out?

It’s August, which means summer break is over, school is starting back up, and sports are around the corner. This also means the overly-compulsive dads, moms and coaches are on high alert. But come on, everyone loves seeing kids run around the field like little drunk adults.

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As a Physical Therapist and Performance Coach, I always get the question – “do you think my son or daughter should play ‘insert any contact sport’?” This is a loaded question, but 11/10 times I will recommend kids to be active in any way they can. Research has repeatedly shown that physical activity and organized sports contribute to better performance in the classroom, improved growth and development, greater social interactions, and positive long-term health habits.

By allowing your son or daughter to take part in sports, there is always an inherent risk of injury. And with contact sports, concussions are always on our radar.

You as a parent or coach may have some questions: What exactly is a concussion? How do I know if my son or daughter has had one? Should I keep them locked up in a dark room forever? When is it safe to let them go back to sports?

My goal is to answer these questions for you. This article will be 1 of a 3-part series related to concussions and how to get ahead (get it?) of these injuries.
Each year, 1.6 to 3.8 million concussions result from sports/recreation injuries in the United States. Sports concussion can affect athletes of any age, gender, or type or level of sport played. While most concussions result in full recovery, some can lead to more severe injuries if not identified early and treated properly.

​Concussion Rates Per Sport
The below numbers indicate the amount of sports concussions taking place per 100,000 athletic exposures. An athletic exposure is defined as one athlete participating in one organized high school athletic practice or competition, regardless of the amount of time played.

• Football: 64 -76.8
• Girl's soccer: 33
• Boys' lacrosse: 40 - 46.6
• Boys' soccer: 19 - 19.2
• Girls' basketball: 18.6 - 21
• Boys' basketball: 16 - 21.2

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Now, does this mean we need to throw in the towel and keep our loved ones from playing sports?  I don’t think so. But context is king, and every individual and situation is different. Is this their first concussion? Did they make a full recovery? These factors and many more go into whether we should let them play.

Concussions can be complex and tricky. It’s not like a broken bone or cut, where these injuries can be seen with our eyes. Concussions are internal injuries, which is we must be educated on what they are and the appropriate steps to handle them.
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So, What's A Concussion?
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• Old theory: A concussion is caused by an acceleration or deceleration of the brain within the skull leading to bruising on the outside of the brain. While the old theory has some validity to it, it is not complete as more research continues to come out.
• New theory: A concussion is a mild form of brain injury that causes a temporary disturbance by shearing of neural cells due to an acceleration or deceleration of the brain within the skull. Think more inside the brain. This leads to a chemical imbalance causing excessive excitability in the brain.

What Causes A Concussion?

• It’s usually due to a significant impact to the head or elsewhere on the body. One common misconception is that a concussion can only happen if there is a signficant hit to the head. But, if the body is hit with enough force while unprepared, it can create a whiplash-like effect leading to a concussion. This is why sports are not the only place where concussions can take place. People who get into car accidents can also present with concussions.

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​Approximately 90 percent of diagnosed concussions do not involve a loss of consciousness, so it is important to look for signs and symptoms of concussion, which is something we will discuss in Part 2 of this series. Stay tuned!

Thanks for reading,

Dr. Ravi, PT, DPT, CSCS