Home NewsStoriesSigns & SymptomsResearchSchoolsCoachesParentsVideosState InfoAbout Us
SportsConcussions.org's
latest concussion news:
Bruins' Savard returns to the ice and a standing ovation after March concussion

Minnesota Wild Bouchard cleared to play Wed after March 2009 concussion, missed 112 games

NCAA hoops star Nored out with concussion after hitting opponent's head, may not make Duke this Sat

Alabama QB McElroy out with concussion in loss to Auburn, second head injury since Oct

Colts receiver Collie suffers another concussion on his first game back 2 weeks after the last one; doctors take his helmet

American Academy of Neurology: Concussed athletes should see a specialist before returning to play


Mayo Clinic Hockey Summit recommendations include ban on all hits to the head at all levels

Army identifies blood protein marker which may help identify brain injuries including concussions

 
What becomes of athletes who suffer concussions when young?


Scott Laker

Ask Dr. Scott Laker:
Seattle Sports Concussion Program

Why are girls more at risk for concussion than boys, statistically speaking?

  Dr. Laker's answer

 
submit question


NFL toughens stance on concussions, acknowledging long-term risks and life-changing potential
 

Recently released NFL helmet-impact test results should not be applied to collegiate, high school or youth helmets

NFL considers changes to camps and practices to limit concussions; concerned about sub-concussive hits

NCAA makes 3-man wedge illegal this year hoping to reduce concussions, same as NFL

Tennessee tightens concussion policies for coming school year

Study suggests athletes may need even more time after concussion to fully heal

NJ female teen athlete suffered 15 concussions now struggles daily

DC MLS star Namoff suspends career due to lingering symptoms from concussion suffered Sept 09

MLB All-Star players choosing reinforced helmets to reduce head injuries

Neuroplasticity: can our brains grow, change, and heal themselves at any age?

Emergency room visits for kids with head injuries increased 43% in the last five years

LaPorta passes neuropsychological test but doctors don't allow him to return to play

Indians LaPorta shows no sign of concussion after on-field collision and CT scan

High school softball adds concussion rule

Pro soccer player Twellman ends season due to symptoms from concussion suffered 2 years ago

Former Bengals receiver who died of unrelated causes showed signs of trauma-related brain damage at age 26

Pirates players collide leaving second baseman unconscious; out for series with concussion

Study shows most parents unaware of their local school's concussion policies

Six-yr-old sustains concussion attempting flip off diving board

Quebec bans bodychecking in youth hockey and reduces concussions significantly

Pro hockey player suffers post-concussion syndrome, symptoms originally confused with flu

Canadian amateur football association implements concussion rules to protect all amateur players

Neck muscle strength plays a role in concussion prevention

ESPN's  Preston Plevetes' concussion story, former La Salle football player

Zackery Lystedt inspired WA State's concussion law, the Lystedt Law

Eagles wide receiver felt pressured by asst coach to return after concussion last season

Concussion Basics
 

Air Force Academy basketball player plaqued by headaches since Nov. concussion, hopes new medication helps

Are headguards the answer for soccer players?  Some athletes and coaches in ME believe so


Head U Concussions





Your concussion questions answered... 

Q:Why are girls more at risk for concussion than boys, statistically speaking?

 A: Dr. Scott Laker  Seattle Sports Concussion Program

We know that female athletes have more concussions than male athletes even when playing the same sports.  Several studies suggest that females have more symptoms immediately after their injury and have longer overall recovery times than males.  While no one knows for sure why this happens, there are several possible reasons that could be behind these differences.

Gender roles still play a part when and if males try to “play through the pain” or minimize their symptoms in order to show their toughness. We do feel that there is something beyond gender roles that may be causing these differences.

One possible explanation is that the presence of estrogen in females is a factor in slow recovery.  The mechanical differences in head and neck size and overall neck muscle strength differences between males and females may have a role to play.  Males and females also have differences in blood flow and energy uptake in the brain that may affect their initial symptoms and overall recovery times.

A review of this topic titled The Female Athlete: The Role of Gender in the Assessment and Management of Sport-Related Concussions is being published in early 2011 by Dr. Tracy Covassin.

Q:Many times it's the athletes who first realize something is wrong, that one of their teammates is not acting quite right in the huddle or on the bench.  Can you address the importance of alerting a coach or another adult immediately?

 A: Ann Whitley, PhD  Sport Psychologist, University of Alaska, Anchorage

The coach has to have the leadership skills to instill in every member of the team the understanding that health and well-being are everyone's number one concern.  This is important because young people have their own code about what they sometimes may think is “snitching.”

Coaches must dedicate training time to team building, health education and symptom identification, particularly with head injuries.  A safety plan must be in place for the entire team that is both smooth and immediate. For example, all adults involved with the organization should be considered safety officials for every athlete on that team.  If everyone knows what to do ahead of time and procedures are in place before an injury occurs, the chances of a good outcome are dramatically increased.

Training for athletes could include information regarding the dangers of not reporting  an injury and student-athletes, coaches, and parents should be required to complete a pre-season safety education program. If everyone is involved the pressure is on the adults, not the athlete to follow through.  The most important objective is building trust so that the youth athlete knows he is doing the right thing by reporting an injury, either his own, or his teammate's.

 

Q:Many times it's the athletes who first realize something is wrong, that one of their teammates is not acting quite right in the huddle or on the bench.  Can you address the importance of alerting a coach or another adult immediately?

 A: Ann Whitley, PhD  Sport Psychologist, University of Alaska, Anchorage

The coach has to have the leadership skills to instill in every member of the team the understanding that health and well-being are everyone's number one concern.  This is important because young people have their own code about what they sometimes may think is “snitching.”

Coaches must dedicate training time to team building, health education and symptom identification, particularly with head injuries.  A safety plan must be in place for the entire team that is both smooth and immediate. For example, all adults involved with the organization should be considered safety officials for every athlete on that team.  If everyone knows what to do ahead of time and procedures are in place before an injury occurs, the chances of a good outcome are dramatically increased.

Training for athletes could include information regarding the dangers of not reporting  an injury and student-athletes, coaches, and parents should be required to complete a pre-season safety education program. If everyone is involved the pressure is on the adults, not the athlete to follow through.  The most important objective is building trust so that the youth athlete knows he is doing the right thing by reporting an injury, either his own, or his teammate's.

 

Q:Could concussions have contributed to the recent suicides of three young athletes?

 A: Chris Nowinski,  CoDirector, Center for the Study of Traumatic Encephalopathy, Boston Univ. Medical Center

There's no way to know for sure at this time. Suicide is extremely complex. In addition, it would be impossible in a single case to link suicide to a brain injury or brain disease. However, there have been a number of recent suicides among confirmed CTE (chronic traumatic encephaolopathy) victims, and the two high school football players who committed suicide after suffering concussions this year is concerning. Having suffered concussions and post-concussion syndrome, I am certain that you aren’t your “usual self” for a period of time after a concussion, and it is clear from research that your brain is not functioning normally. We need to explore this link further, as there may be opportunities for prevention.

 

 

Q:Do mouthguards prevent concussions?

 A: Dr. Scott Laker  Seattle Sports Concussion Program

The most recent systematic review on this topic (Br J Sports Med 2009;43:i56-i67) basically states that no strong evidence exists to suggest that mouth guards prevent concussions.  The studies on mouth guards are of variable quality, use different definitions of concussion, and represent a very small number of athletes.  There are several mouth guards on the market that claim to prevent concussions but there is no high-quality data to support those claims.

Q:I am concerned about radiation exposure from a CT scan, and if most CTs and MRIs are negative for concussion, how do the doctors decide who needs one?

 A: Dr. Scott Laker  Seattle Sports Concussion Program

As you mentioned, imaging in concussions is almost always negative and doesn’t often help guide the athlete’s treatment plans.  CT scans and MRI’s don’t “rule in” concussions but they do “rule out” more serious intracranial bleeds and other less common brain diseases that may mimic concussion symptoms.

CT scans are usually ordered as part of an emergency room workup for patients that may have bleeding inside of their skulls.  These bleeds are rare but can be extremely serious and may require surgery.  After the first few days, CT scans have less of a role in concussion management.  MRI’s are usually ordered in outpatient clinics once emergency problems have been ruled out.

 Emergency room doctors make decisions about CT scans based on the athlete’s symptoms, physical examination, and history.  In outpatient clinics, physicians may order an MRI if the athlete’s history and physical exam suggest another diagnosis or if the symptoms are prolonged or severe. 

 It is important to know that not every athlete with a concussion needs a CT scan or MRI.  Your physician should be willing and able to explain to you and your family why or why not to have advanced imaging.

Q:If all the doctor is going to tell us to do is rest after a concussion, why should I schedule an appointment for my child?

 A: Dr. Scott Laker  Seattle Sports Concussion Program

Concussions are a serious injury to the brain.  Thankfully, the majority of these injuries heal quickly and don’t cause any permanent issues.  Most families benefit from sitting down with an experienced healthcare provider to learn more about the condition and to have their questions answered. 

 The doctor’s visit is a time to review exactly how the injury occurred, the symptoms that are present, and to perform a thorough physical, neurologic, and concussion exam.  Concussions usually occur after big collisions that can cause other injuries that may need further workup. 

 In the first few days to a week after a concussion or in athletes with mild symptoms, the doctor will recommend rest and offer education and advice on how best to avoid sustaining another concussion. We often recommend temporary school accommodations during the athlete’s recovery and can discuss these recommendations with your school.  We also offer advice regarding physical, mental, and extracurricular activity. 

 Athletes with severe symptoms or symptoms lasting longer than 2 weeks should be seen by a healthcare professional for a complete history and physical exam and to create a plan to help them continue to succeed in school.

Q:As a coach, I remove any athlete that I think may have suffered a concussion, from practice or a game.  But how do we decide when to call an ambulance?  We don't have medical help on the sideline.

 A: Dr. Scott Laker  Seattle Sports Concussion Program

Here are some important guidelines for deciding who should be transported to the hospital by ambulance, NOT mom/dad's vehicle.  Any athlete who exhibits:

  • Prolonged LOC (longer than 30 seconds to 1 minute should go to the ED)

  • Declining level of consciousness

  • Neurological signs (pupils of different size, weakness of a limb)

  • Prolonged vomiting

  • Seizure activity

  • Athletes with significant neck pain

    The Acute Concussion Evaluation (ACE) Home/School Instructions Form has useful information for those with a concussed child at home, whether or not they were transported to a hospital.  It provides a checklist of symptoms that may require further evaluation.

 

Q:My son suffered a concussion and can't remember the play that caused his injury.  Should we ever expect him to remember what happened, and is this memory issue indicative of the severity of the injury or his recovery outcome?

 A: Dr. Scott Laker  Seattle Sports Concussion Program

This problem with the memory around the time of the injury is known as post-traumatic amnesia (PTA) and is a very common symptom after concussions.  Essentially, the trauma that caused the concussion temporarily causes the brain not to be able to create or store memory.  This “blind spot” in the athlete’s memory may take weeks to months to fill in, and in many cases, it never returns.  There is also retrograde amnesia (RGA), which is difficulty remembering the events that happened before the concussion.  The RGA and PTA both tend to shrink and the athlete tends to remember more and more around the time of the injury.  Athletes may never fully regain those memories, but it is not a sign that the brain has not recovered.  Neither RGA nor PTA are considered “symptoms” for recovery or return-to-play issues.

Q:My 14-yr-old daughter has not played soccer for three weeks due to a concussion.  She is more moody and irritable than normal.  Can a concussion actually cause these symptoms?  I know she's frustrated.

  A: Dr. David Coppel  Seattle Sports Concussion Program

Along with physical and cognitive symptoms associated with concussion, athletes can also experience emotional symptoms, which often involve some moodiness and irritability. In some cases, concussed individuals just feel more emotional in general or their emotions are "closer to the surface."  

Because these symptoms can be common to teenagers pre-injury, the description of the athlete being more moody and irritable than normal, is the key.issue.  Some concussed athletes are able to self-report these symptoms, but in some instances, parents and other available observers may have important input about these symptoms.  It is also important to note that for some athletes, their sport involvement is an outlet for their stress and a strong structure for their identity and social interactive lives, and thus, the loss of that activity for an extended period of time can produce some of these emotional symptoms.  Many concussed athletes do not experience or endorse depression per se, but will describe being frustrated, disappointed, or impatient (with being concussed and the recovery process).

 

Q:How many concussions can my son sustain before he should stop participating in high risk activities such as contact sports?

  A:  Dr. Scott Laker  Seattle Sports Concussion Program

Unfortunately, there is no “magic number” for concussions.  Some athletes can have several concussions without ever needing to retire while other unlucky athletes have to retire after just one concussion.  We know each concussion makes an athlete more likely to have another one in the future.  We also know that athletes with multiple concussions tend to have symptoms longer than athletes that have never had a concussion.   

 We get very concerned when athletes that have a history of several concussions start having:

·         Concussions that happen after smaller and smaller blows to the head

·         Increasing  number of symptoms

·         Increasing severity of symptoms

·         Increasing duration of symptoms

 

When we see this pattern, we may recommend that an athlete consider changing sports or retiring from contact sports entirely. Athletes that have had more than one or two concussions should consider seeing a specialist to discuss these issues.

Q: My teenage son has had multiple concussions but has been symptom-free for 9 months.  Can we assume his brain has fully healed and permit him to play contact sports again without worrying about "Second Impact Syndrome"?

   A: Dr. Scott Laker  Seattle Sports Concussion Program

Second Impact Syndrome (SIS) is a devastating result of a second concussion that happens before a first concussion has fully healed.  It causes massive brain swelling and results in death or severe disability.  SIS can happen weeks after the first concussion.  This is one of the main reasons why doctors recommend that no athlete should return to sports before the symptoms of their concussion have completely resolved.  Once an athlete is symptom-free, we have them go through several days of exercise trials before returning to practice or play.  This makes sure that the athlete is safe to return and that we can prevent SIS.

Gradual return-to-play guidelines

Q: How can I make sure that my doctor is knowledgeable about current return-to-play guidelines?  I don't want my daughter cleared too early.

  A: Dr. Scott Laker  Seattle Sports Concussion Program

Most doctors’ office staff will know exactly what their doctors specialize in.  Ask them before you schedule your appointment if the doctor takes care of concussions frequently.  Once you are at your appointment, feel free to ask how many concussions your doctor manages, how they manage them, and how they make their decisions for return-to-play.  You should hear answers that involve a stepwise return-to-play and never allow a symptomatic athlete to return early.  However, if your athlete has had multiple concussions or has severe or long-lasting symptoms, I recommend that they see a doctor that specializes in sports concussions.

Gradual return-to-play guidelines

Q:I'm a coach and one of my players was cleared by his doctor, but I've heard from others that he still has headaches.  What should I do?

  A: Dr. Scott Laker  Seattle Sports Concussion Program

This is a tough position to be in for any coach. You know your athletes better than anyone and have a clear decision to make.  If you are concerned that the athlete is still having symptoms, sit them down and ask them exactly what they are feeling.  Be specific and make sure that they are totally symptom-free before putting them back in the game.  If they are still feeling sick, then do not return them to practice or play.  If you need clarification, ask the athlete’s parents to have the doctor contact you to discuss the case.  No doctor wants to return an athlete if his or her coach thinks they aren’t ready and should be happy to talk with you once they get permission from the parents.  If you are still concerned, sit the athlete out and recommend a second-opinion before returning them.  It’s the right thing to do and it will make sure you and your team have a healthy season.
 
Gradual return-to-play guidelines

Q:  My high school does not have a concussion policy and we do not have a state law either.  What can I do to ensure that athletes are properly cared for?

     A: Dr. Scott Laker  Seattle Sports Concussion Program

 It is great that you are working to keep your athletes safe this season.  The most important thing that any school can do is to make sure that the athletes know the symptoms of concussion and report them to their coaches or trainers immediately.  At that point, the athlete should be removed from play or practice and not return to sports until symptoms resolve When in doubt, sit them out.  You can also work to find a doctor in your area that specifically takes care of athletes with concussions.  This may be a physiatrist, neurologist, orthopedist, or pediatrician.  Your family doctor or team physician is a great person to ask for a recommendation on a doctor in your area that can help take care of your athletes with concussions. 

The CDC just released a new concussion video for coaches which would be of great value, particularly in schools where there might be limited information.  Coaches, parents, and athletes should be encouraged to view the program and distribute the accompanying free, downloadable CDC materials to all concerned.  Education really is the key to protecting your athletes, along with the other avenues I mentioned.  Keep up the good work.

Q: Now when I watch my 9-yr-old daughter play soccer I am concerned that she will suffer a concussion and I won't know it.  Are the symptoms different in younger children than in high school athletes?

     A: Dr. Scott Laker  Seattle Sports Concussion Program

 Recognizing concussions on the field can be challenging, regardless of age.  The symptoms of concussion are similar in young athletes and older athletes. It is important to remember that our younger athletes might not recognize that something is wrong.  An athlete is having balance problems, confusion, or is simply not “acting like themselves” should be removed from practice or play and evaluated. For that reason, we recommend our coaches and parents be even more careful with younger athletes

Q:It's not uncommon for students who have suffered concussions to return to school with headaches and other symptoms.  Should they stay out of school until they are completely symptom-free?  They typically want to return so they don't fall behind. (submitted by school nurse)

     A: Dr. Scott Laker  Seattle Sports Concussion Program

In general, we prefer to have student-athletes get back to school as quickly as possible even if it requires a modified schedule.  One solution is to make use of easy changes to avoid the athlete’s main symptoms.  We often suggest shortened school days, decreased homework, frequent breaks during class, and extended test-taking time.  If the symptoms are too severe and the athlete simply cannot attend school successfully, we do recommend that the student-athlete stay home temporarily.  If you have a student that is having difficult returning to school after a few days, I would recommend that they see a physician. 

CDC Heads Up to Schools: Know Your Concussion ABCs for additional information and downloadable materials for school nurses and other school personnel

Q: What happens inside the brain when a concussion occurs, and what are we waiting for as the brain heals?                        

    A: Dr. Stanley Herring  Co-Medical Director, Seattle Sports Concussion Program

Essentially, it’s a mismatch of supply and demand.  The brain cells need energy to repair themselves during a time when they can’t get enough.  These changes that happen during concussions occur at the cellular level.  While the brain tissue itself appears completely normal on MRI or CT imaging, the brain cells are not functioning properly.  After the initial hit that causes the concussion, there is a release of neurotransmitters that cause ions to move in and out of the brain cells abnormally.  Calcium rushes in while potassium rushes out of the cells, disturbing the balance of electrical charges.  The brain cells have to work very hard and use a large amount of energy to restore their normal balance.  At the same time, there is a decreased blood flow to the brain, limiting the cell’s energy supply. It is this “energy crisis” is why the brain is so vulnerable when an athlete is concussed.

What are we waiting for as healing takes place? The management of concussion is largely keeping the athlete safe while the supply and demand mismatch resolves.  The majority of athletes resolve over the course of 1-2 weeks but some athletes may take months to completely recover.  There are a number of factors that seem to influence recovery time including past medical history, previous concussions, age, etc.  It is vital that athletes do not return to play while still having symptoms of a concussion. 

Q: My school district just implemented computerized "baseline" testing for all athletes.              Do these tests work?

    A: Dr. Gerard Gioia Chief, Division of Pediatric Neuropsychology, Children's National Medical Center, Wash DC

Computerized baseline neuropsychological tests can work but only if handled properly by the appropriately trained personnel. It is important to recognize several important points: 

(1) Do not be fooled by the apparent “ease” of this testing simply because it is delivered on a computer. They are complex cognitive measures that must be handled properly.

(2) The tests must be properly administered by trained testers, and taken seriously by the student-athlete to obtain valid findings.

(3) The tests are only one part of the post-concussion clinical exam. Symptom assessment, assessment of balance, and response to cognitive and physical exertional activities must also be considered.

(4) The interpretation of the neuropsychological test findings is a complex process, and should include a well-trained neuropsychologist at the very least as a consultant to the school district.

 

Q: My teenage daughter was playing soccer and collided with a teammate.  They bumped heads, both were knocked to the ground, but neither of them lost consciousness.  My daughter was a little slow getting up but both girls said they were fine.  Should I be worried?

    A: Dr. Scott Laker  Seattle Sports Concussion Program

 Collisions occur frequently in sports, especially soccer, and we need to do a better job recognizing them when they occur.  It is important to watch athletes that have been involved in collisions for developing signs and symptoms of concussion.  We know that less than 10% of concussions involve any loss of consciousness so we have to be aware of other, more subtle signs like headache or confusion.  Many athletes, including teens, are unfamiliar with other important symptoms of concussion such as sensitivity to light or noise, balance problems, etc.

If you, or anyone, is concerned that your daughter may have suffered a concussion, she should be removed from play immediately, evaluated with a sideline assessment, like a SCAT 2, which should include an exertional challenge.  It's important to observe the athlete after the collision as some symptoms don't show up right away.  If she feels well, does not have any symptoms, and performs well on her sideline testing she can return to the game if cleared by the sideline medical staff.  Remember, when in doubt, sit them out.

 

   
 


Youth Sports Concussion - Prevention, Diagnosis, News

Copyright © 2010 SportsConcussions.org.  All Rights Reserved. 
SportsConcussions.org does not provide medical advice, diagnosis or treatment.  Additional Information

Phone: 360-775-8197
Editor: Jean Rickerson: SportsConcussions.org
Main Email: SportsConcussions@yahoo.com
Connecticut Office: SportsConcussionsCT@yahoo.com
Rhode Island Office: SportsConcussionsRI@yahoo.com
Facebook: SportsConcussions@yahoo.com
More:   Contact Information