When In Doubt, Sit It Out!

This week, we will discuss concussions.  With football teams starting conditioning camps soon, it is a subject to shed some light onto.  We have all seen how professional sports are taking serious steps to reduce the rate of concussions and to properly care for those who have sustained concussions.  Almost a year ago, I completed my Master’s degree with a capstone paper on concussions in football.  In the paper, I compared American football to rugby union.  The rules in rugby are designed to minimize contact with the head.  They are taught to tackle in a way that minimizes contact to the head.  But does this prevent concussions?  Absolutely not!

Can we prevent concussions?  Absolutely not!  Let’s not kid anyone.  Accidents happen.  Stuff falls and hits you in the head.  Bats slip out of players’ hands.  Balls are thrown offline.  Low lying branches.  Slippery rocks.  There are too many ways that injuries can happen without even being involved in a sport that involves collisions between bodies or the body and the ground.

Next question: do you have to get hit in the head to cause a concussion?  Absolutely not!  A sudden change of momentum and/or direction that causes your brain to jerk around in the protective fluid inside your skull can cause a concussion.  Consider a receiver running full speed, looking back at the ball coming, puts his hands up to catch it, when suddenly a strong safety comes across at full speed and hits the receiver straight in the chest knocking him backward.  The conditions of this, especially head turned and the sudden change in momentum/direction could cause a concussion.

I was hit in the head hard but did not get knocked out.  I felt dizzy and had a headache but don’t have a concussion because I remember everything and was never knocked out, right?  Wrong.  Loss of consciousness (LOC) is not a determining factor with concussions.  The list of signs and symptoms provided later is useful.

Do helmets help?  Yes and no.  There are studies that show that when someone puts a helmet on, it tends to give them more confidence and a feeling of invincibility.  In my paper, I found a study looking specifically at rugby players and “scrum caps.”  These are caps that are soft sided and help to reduce the risk of lacerations and rubbing injuries to the ears or head in the scrum.  Finch, McIntosh and McCrory (2001) studied how the players felt about wearing them.  The main points to take from the results are:

  • The players felt that the “helmet” would prevent concussions
  • The players felt safer
  • The players played more aggressively

In rugby, using the head as a main point of contact by the tackler or as the primary target on the ball carrier is a major infraction.  American football has taken big steps to eliminate or at least significantly minimize head contact.  “Targeting” has become a major infraction and can get a player ejected from a game.

This brings me to the next point and it’s something I tell players: the helmet is meant only as protection in case things do not go perfectly.  Things will not go perfectly.  The helmet is not a weapon.  The helmet is not designed to allow you to use your head as a primary point of contact.  It is merely a safety piece of equipment in case you get hit in the head.

But, I have seen helmets that are designed to break apart with hard impacts to prevent concussions.  Correct, the helmets are designed to break apart with significant impact.  Is it designed to “prevent” concussion?  Nope.  It is designed to reduce forces that can cause a concussion.  If a helmet breaks apart, rest assured, the impact was significant and there is likely a concussion or worse.  Precautions must be taken.

This brings us to the point of what to do if you suspect a concussion.  If you or someone you know has fallen, hit his head, was hit in a game, etc. and you notice dizziness or headache immediately or shortly thereafter, this is enough for doubt.  It’s time to start paying attention.  Here is a concussion checklist:

Scoring on this table:  0=none, 1-2=mild, 3-4=moderate, 5-6=severe

Symptom 0 1-2 3-4 5-6
1.      Headache        
2.      Pressure in head        
3.      Neck pain        
4.      Nausea or vomiting        
5.      Dizziness        
6.      Blurred vision        
7.      Balance problems        
8.      Light sensitivity        
9.      Noise sensitivity        
10.   Feeling slowed down        
11.   Feeling in a fog        
12.   “Don’t feel right”        
13.  Difficulty concentrating        
14.  Difficulty remembering        
15.  Fatigue or low energy        
16.  Confusion        
17.  Drowsiness        
18.  Trouble falling asleep        
19.  More emotional        
20.  Irritability        
21.  Sadness        
22.  Nervousness or anxiousness        

Moses (2012)

This is a nice tool to have, but anyone who suspects a concussion should be checked by a medical professional.  We provided this to help you all understand the numerous signs and symptoms to watch for.  Again, if you suspect a concussion, please get checked.

We will get specific to football as that season is sneaking up on us.  In California, we are required to have an ATC or an MD on the sidelines for injuries.  I do not know the laws of other states but I would assume (hope) that they have similar laws.  If the ATC at the high school where I coach suspects a concussion, he will immediately take the player’s helmet.  This makes it so the player cannot return to the game.

Hopefully, football programs are catching on to the professional level and making the proper changes and talking to their players about being honest about their symptoms.  If you have kids playing sports and the sideline medic reports possible concussion to you, please follow his or her instructions closely.  And – When in doubt, sit it out!

If you have any questions or comments, please comment below.  We are happy to help!

Finch, C.F., McIntosh, A.S., McCrory, P. (2001). What do under 15 year old schoolboy rugby union players think about protective headgear?  British Journal of Sports Medicine, 35, 89-94.  Retrieved from: http://bjsm.bmj.com/content/35/2/89.full.pdf+html on July 20, 2017

Moses, S. (2012). Concussion symptom checklist.  Retrieved from: http://www.fpnotebook.com/er/exam/CncsnSymptmChcklst.htm on July 20, 2017