What is a Concussion?


Keith W. Lawhorn MD
Orthopaedic Surgeon
Commonwealth Orthopaedics and Rehabilitation
1.     What is a concussion?
A concussion is a mild traumatic brain injury (TBI) caused by a blow to the head or a whiplash-type injury where the head is jarred violently back and forth. The injury to the brain occurs when the brain itself forcibly moves back and forth within the skull cavity.
2.     Do concussions happen only with football?
No. Concussions can occur in virtually any sport where a blow to the head or a collision between two athletes or with a fixed object including the ground or a wall such as hockey boards. The rapid deceleration of the athlete’s body in the cases of collision leads to the same deceleration of the skull and brain causing the brain to forcibly strike the skull within its space.  
3.     Does the use of protective headgear lessen concussion incidence?
No. In fact, the incidence of concussions has risen for two reasons. Better protective headgear leading to higher energy of collisions and an increased awareness for identifying concussions. In fact the incidence of concussions in traditional American rules football is higher than in rugby where no protective headgear is utilized.
4.     How are concussions best diagnosed?
Witnessing the event. Any young athlete experiencing a forceful collision or blow to the head should raise the question of concussion. If “Johnny gets his bell rung”, in all likelihood he has a concussion. Any athlete complaining of concussion-like symptoms after a forceful collision or blow to the head has a concussion.  There are no objective clinical studies or imaging such as x-ray, MRI, or CT scans that confirm the diagnosis of concussion. Imaging studies are performed when other diagnoses are being considered.
5.     What are the symptoms of concussion?
Temporary loss of consciousness, headache, amnesia, dizziness, confusion, nausea, vomiting, blurred vision, insomnia and difficulty concentrating may all be associated with concussion.
6.     How long might concussion symptoms typically last?
Concussions can vary with regard to severity. Typically most symptoms resolve on the order of 7-10 days. However, in some athletes symptoms may last for weeks to months and sometimes even a year. Athletes with a prolonged duration of symptoms are diagnosed with post-concussion syndrome.
7.     What should parents and coaches do if they suspect an athlete has had a concussion?
The athlete must come out of the game. “When in doubt, sit them out” is a common slogan used to manage the concussed athlete. Young athletes with concussion symptoms would be best evaluated by a sports medicine internist or neurologist trained in the management of concussion. Neuropsychological testing can be performed to establish a baseline of brain function and can be used to monitor progress and recovery from concussion.
8.     When can an athlete return to play following an obvious concussion?
Return to play is best determined by a healthcare physician trained in the management of concussion as stated in 7 above. Athletes must gradually progress to a return to physical activity while monitoring for concussion-like symptoms. Initial treatment requires both physical and mental rest. 

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