Concussion questions: What to know

By Katie Grevlos, BA, Augustana University and Thayne Munce, PhD, Sanford Sports Science Institute

What causes a concussion?

A concussion is caused by a direct or indirect blow to the head that results in vigorous and abrupt movement of the brain within the skull. Concussions may occur from impacts of varying magnitude to any region of the head or by a whiplash effect from a blow to the body. While concussions are more likely to be caused by higher magnitude impacts, they can result from moderate impacts as well and are not always caused by the hardest hit an athlete experiences. Concussions result in impaired neurological function and have various signs and symptoms that are unique to each injury and individual.

How common are concussions in youth sports?

According to the Centers for Disease Control and Prevention (CDC), an estimated 1.6 – 3.8 million sports- and recreation-related concussions occur every year. This number includes many concussions that are not reported by youth athletes and therefore go undiagnosed. From 2001-2005, an estimated 500,000 emergency department visits were made by children aged 8-19 for diagnosis and treatment of concussions. Thus, about 4 in 1000 children aged 8-13 and 6 in 1000 children aged 14-19 were admitted to the hospital for sport-related concussions during this time period. In 2007, a different report stated that the incidence rate of concussion was 0.23 concussions per 1000 athlete exposures, meaning that approximately one concussion occurred for every 4000 athlete exposures (one athlete exposure = one individual participating in a single practice or game). Game concussion rates are typically higher than practice rates. Among youth athletes, concussion rates are highest in football, ice hockey, soccer, and lacrosse. However, concussions also occur in nearly every other sport and sport-related activity (bicycling, swimming, cheerleading, gymnastics, etc.).

Are there long-term effects of coConcussionJpegncussions?

Research suggests that there may be long-term effects of concussions and other sports-related brain injuries, particularly if athletes incur multiple concussions. Repetitive brain injury increases one’s risk of subsequent concussions and may exacerbate symptoms from a previous injury. Second Impact Syndrome, although rare, may occur if a second concussion is sustained before there is full recovery from the initial injury. This potentially fatal condition occurs primarily in children. Repetitive brain trauma and/or concussions may also be associated with Chronic Traumatic Encephalopathy (CTE), a brain disease that triggers degeneration of brain tissue and is associated with an abnormal development of a certain protein within the brain. Some symptoms identified with CTE include memory loss, aggression, confusion, concentration difficulties, and early signs of dementia. Although there is no definite cause and effect relation between concussions or repetitive head impacts and CTE, several athletes with histories of repetitive brain trauma, primarily former professional football players, have been diagnosed with CTE after their death. The prevalence of this disease in football players, or any other athletic population, is unknown at this time and remains a controversial subject, even among experts. In summary, the cumulative effects of traumatic brain injuries may lead to an increased risk of cognitive impairment and neurodegenerative disease later in life. However, much more research is needed before definitive statements about long term injury risk can be made.

When is it safe for youth athletes to return to play after having been diagnosed with a concussion? What is the estimated time of recovery?

Youth sports concussion laws have been put into place to ensure proper education and protection from concussions and other brain injuries. In 2009, the Zackery Lystedt law was passed in Washington State. Since then, all states in the U.S. have passed their own youth concussion laws modeled after this original legislation. The Lystedt law maintains that youth athletes should not return to play until a) all concussion symptoms have been resolved and b) clearance is obtained from a trained health care provider. Under no circumstances should an athlete be allowed to return to play the same day after enduring a concussion. Premature return to play increases the risk of further injury and may cause symptoms to persist and/or worsen over time. Once diagnosed, it is recommended that athletes limit both physical and cognitive activity, as rest may facilitate recovery. Athletes should also complete a graduated return to play protocol with progressive steps of physical activity and symptom monitoring before returning to full-contact activity. There is a great deal of variability in both the severity and recovery time of individual concussions. While many concussed athletes recover within 7-10 days, others may take several weeks, or even months, to fully heal. Therefore, it is important to monitor symptoms closely and regularly consult with a health care professional who is trained in the care and management of concussions. 

Are there specific recommendations for the prevention of concussions in youth sports?

While there is no way to prevent sport concussions entirely, there are ways to reduce the risk of concussion and brain injury in youth sports. First, athletes should wear all of the protective equipment that’s recommended for their sport. Research suggests that helmets, given that they fit properly and are in good condition, significantly reduce the risk of catastrophic head injury among athletes. Unfortunately, although properly fitted helmets may lower the risk of concussion, they are not able to prevent all concussions from occurring. The use of mouth guards has also been purported to reduce the risk of concussion. However, evidence suggests that mouth guards play a bigger role in preventing oral injury than they do in preventing concussions. In youth sports, it is crucial to minimize unnecessary contact and collisions during practice. For example, in football, reducing contact time and eliminating deliberate hits to and/or with the head greatly decreases head impact exposure and may lower the risk of concussions. The restriction of body checking in hockey can also reduce the risk of concussions and injury by decreasing the number of forceful collisions a player experiences. Fair play should always be encouraged during games and practice in order to minimize illegal and unsportsmanlike conduct between players. Likewise, athletes and coaches should abide by established rules and guidelines of their sport and utilize proper techniques that enhance player safety. Furthermore, it is important to promote awareness of the dangers of concussions by educating coaches, parents, and athletes about the risks involved.