Dr. Krystian Bigosinski
MOR Sports Medicine Physician

Every fall, the football season starts just as reliably as the changing of the leaves on the trees. And just as reliably, sports medicine doctors begin to see a spike in the number of concussed athletes at our clinics.

Our understanding of concussions, although still incomplete, has grown vastly over recent years, and our guidelines for returning athletes to the playing field have reflected this. In the past, "getting your bell rung" during a football game was seen as a right of passage and was often treated with smelling salts, a slap on the shoulder pads, and getting put back into the game.

A recent study showed that as many as 30% of all high school football players had a history of a concussion and 15% had a history of concussion within the current season. A 2004 study of collegiate football players also noted that players with recurrent concussions had longer recoveries than players with no prior concussions. There have also been links between concussions and prolonged symptoms such as anxiety, depression, difficulty concentrating, headaches, and vision changes. This group of lingering symptoms is often referred to as post-concussion syndrome.

Furthermore, every year a small but significant number of athletes die or sustain permanent brain injuries from second impact syndrome. This occurs when a player has a concussion and soon thereafter receives another blow to the head, resulting in massive and rapid swelling of the brain.

With this knowledge, all sports at all levels of competition must take concussions seriously. This begins with the players reporting unusual symptoms, such as dizziness, nausea, blurry vision, feeling "dazed" or "groggy" after receiving a blow to the head. Coaches, athletic trainers, or team physicians must then begin frequent and repetitive evaluations of the athlete on the sidelines.

If an athlete has sustained a concussion, the current universal guidelines (as described by the 3rd International Consensus Statement on Concussion in Sport) recommend withdrawing the athlete from competition. If the athlete's condition deteriorates on the sideline, they should be rapidly transported to a hospital for evaluation. Additionally, any athlete who is unconscious must be treated as if they have a serious neck injury. The athlete must then be withheld from exercise until their concussion symptoms have resolved. Some of the symptoms may be subtle, and evaluation by a physician with experience in treating concussions is of the utmost importance prior to returning to play. Once an athlete has been cleared by a physician, a step-wise reintroduction to exercise must be taken to ensure that the athlete does not have any concussion symptoms with exertion.

While these general guidelines are important, every concussion must be treated on a case by case basis. That is why determining appropriate care and return to play of concussed athletes can be difficult. It is best to take a team approach which includes educating players, parents, and coaches on concussions, working with athletic trainers who take care of teams, and seeking the care of doctors who specialize in the diagnosis, treatment, and care of concussed athletes. By doing this, athletes can be returned to their sport in a safe and controlled manner, greatly reducing the risk of long-term consequences.

View Consensus Statement on Concussion in Sport, 3rd International Conference on Concussion