Unmasking the 'Invisible Injury': Knowing Concussion Signs Saves Lives

To a teen athlete, the health risk of a concussion can seem small compared to their powerful desire to stay in the game and help their teammates. That's one reason adults on the sidelines have a critical role in assessing athletes for symptoms of concussions.

"If an athlete sustains a potential head injury, certified athletic trainers and team physicians need a specific protocol to determine if they're able to return to the game," says John Burnside MS, ATC, LAT, practice manager at AdventHealth's Sports Concussions Program.

Though coaches and others can receive training in identifying a concussion, they're not a replacement for a certified athletic trainer. The outward signs of a concussion can be subtle, but the risks they carry can be severe.

"Concussions can range from mild to severe, and while the symptoms are not always obvious even a mild concussion is a brain injury, and we have to take that seriously," says Burnside, who has served as a head certified athletic trainer in division 1 college athletics for 12 years.

An estimated 2.5 million high school students report having a concussion each year. There are significantly higher risks among students who play multiple sports.

As part of our partnership with Volusia County Schools, AdventHealth will help the district strengthen its concussion protocols. It will also dedicate a certified athletic trainer to act as a liaison with the schools.

While trainers and other medical staff are the experts, not all concussions occur during a game. Some occur during a practice, where a certified athletic trainer is less likely to be present, or off the field entirely. Therefore, being educated about concussions can help prevent serious brain injury among children and teens.

"Certified athletic trainers can't be everywhere young people sustain head injuries, so we hope that more public awareness will spare more kids the potentially devastating consequences of untreated brain injury," Burnside says.

What Concussion Looks Like

A concussion occurs when the brain bounces around in the skull, often after a fall or hit to the head. There are two ways to think about concussion symptoms in youth athletes: how they act and how they describe their symptoms.

According to the Centers for Disease Control and Prevention, parents can observe some of the following signs of a concussion in a youth athlete:

• Changes in mood, personality or behavior
• Forgetful about what happened just before or after the injury
• Acting stunned, dazed, confused or forgetful, such as about their position or the game
• Slow to answer questions or move clumsily
• Losing consciousness, even briefly

The players themselves often describe their symptoms in the following ways:

• Balance problems
• Bothered by light or noise
• Feeling sluggish, foggy, hazy or groggy
• Headache or "pressure" in the head
• Confusion, memory or concentration problems

These symptoms usually show up right after a hit, but it can take hours or days to notice something isn't right. Even if you're not sure a concussion happened, children should not return
to their game until they've been evaluated by a medical professional.

"Concussions can look different in every child," Burnside says. "You know your child best, so don't hesitate to get your child examined if something seems off."

The CDC recommends that parents call 911 or take their child to the emergency room if he or she has any of the following symptoms:

• One pupil is larger than the other
• A headache that gets worse and does not go away
• Slurred speech, weakness, numbness, or decreased coordination
• Drowsiness or inability to wake up
• Brief loss of consciousness (passed out/knocked out)
• Repeated vomiting or nausea shaking or twitching
• Unusual behavior, anxiety, restlessness or confusion

Each case is going to be different based on the nature of the injury and patient symptoms. Concussions are actually not diagnosed through an MRI or a CT scan. They are functional injuries that result in changes in mental status.

"We need to monitor signs and symptoms and educate the public on what to look for after a suspected injury," says Burnside. "Go to the ER only if there is a loss of consciousness at the time of injury, severe headache that is worsening over time, repeated vomiting, slurred speech, visual problems, or unresponsiveness. Parents who are unsure should schedule an appointment with a health care provider in a clinic equipped to evaluate for a concussion."

Though the majority of concussions among high school athletes happen in football, they can also happen in other sports. Among girls, soccer results in the most concussions, both from collisions between players and from heading the ball.

It's critical to remove a child from play after a concussion because follow-up concussions occur more easily and can be more serious, even fatal. Early on, the treatment for a concussion is rest, both from the sports itself and other strenuous activity, including school. After the initial rest phase, certain activity can be therapeutic and can stimulate recovery. Therefore, it is important each concussion be evaluated by a qualified health care professional in a timely manner.

For parents who want to be proactive they should schedule a baseline test, and be ready with a plan in case your child has a suspected injury. The AdventHealth Sports Concussion Program offers comprehensive testing including memory, reaction time, balance, and other factors before and after an injury occurs. That way, if a concussion is suspected, the athlete can be re-tested and their scores compared against earlier tests.

How Certified Athletic Trainers Can Help

The Mississippi player, Dennis Mitchell, had asked to return to the game, according to press reports.

In the absence of an expert opinion, it's not uncommon for young athletes to disregard their health risks in favor of helping their team. A study in the Journal of Athletic Training found more than half of high school athletes said they would hide a concussion.

The certified athletic trainer provides valuable medical perspective that is respected on the field by both players and coaches.

The message is getting through: More awareness of concussions is helping us recognize them more often. There has been an 87 percent increase in the diagnosis of concussions from 2007 to 2014 in teens ages 15 to 19. In children ages 10 to 14, it was even higher, at 143 percent.

Currently, the state of Florida requires student-athletes under the age of 18 be formally cleared by a physician prior to return to play. This includes a graded step by step progression back to sport, also known as the AT18 protocol. In collaboration with a physician, a certified athletic trainer can properly manage these steps to ensure the health and safety of our youth.

At the AdventHealth Sports Concussion Program, we know about the many physical, social and emotional benefits of youth sports. That's why we work with individual children and families to develop treatments that work for them - and get them back on the field.

To schedule an appointment at the Sports Concussion Program, visit our website or call Call407-303-8012.