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Concussion in Sport

The purpose of this update is to give you a brief overview on brain injury and concussion in sports. We are attempting to take a pro- active role on the topic so you will have a better understanding of what to expect when your athlete sustains a concussion.

Brain Injury Effects

The exact short-term and long-term effects of concussion are still evolving. One thing is clear, concussions are cumulative. After the first concussion the athlete’s risk of a second concussion increases by 400%. With each concussion it becomes easier to sustain another concussion. After each concussion the symptoms become more severe and last longer.

The exact effects of multiple concussions are also far from being clear. Long-term effects include vision problems, memory deterioration, impaired balance, loss of coordination, and persistent headaches. These symptoms also may not improve over time.

The long-term effects of multiple concussions have ended numerous professional careers, including Stan Humphries, Al Toon, Harry Carson, Merryl Hoge, and Brett Lindros to name a few. The possibility exists these situations were due to mismanagement of earlier concussions.

Second Impact Syndrome (SIS) is another consideration. With SIS the athlete returns to play before all concussive symptoms have resolved, receives a second (often minor) head trauma that results in rapid brain swelling and ends in death 50% of the time (even with emergency room intervention). It is also preventable by simply recognizing and appreciating the signs and symptoms of a concussion.

Our Approach

Because of the potential catastrophic and the long-term effects of concussion we take a serious and conservative approach in their management. Your cooperation and assistance are crucial for the long-term well being of your athletes. In particular you can do the following things:

Return to play after a concussion is not a toughness issue, Do Not Make it One. Inform the Athletic Training Staff when your athlete receives a possible concussion (athletic related or not). Inform me personally if a head injury occurs during an away game.

There are no universal standards for grading the severity of a concussion, nor universal standards for return to play after a concussion. We currently follow the guidelines established by the Colorado Medical Society (attached). However, we constantly review this information and new standards as they are presented. If we change the guidelines we follow I will inform you accordingly.
Recognizing a Concussion

One of the most common errors is the assumption that a concussion only occurs when an athlete is “knocked unconscious”. This is simply not the case. The majority of concussions do not involve loss of consciousness. But they still demand priority management and caution because a brain injury has occurred. In the case of concussions 1 1 does not equal 2. The effects of multiple concussions are exponential, 1 1 might equal 4 or more.

Note in the Concussion Guidelines that three grade 1 concussions during a single season terminates that athlete’s season. The reason for this is the cumulative effect of multiple concussions.

Your awareness and assistance in recognizing subtle signs of a concussion are imperative. You are in an ideal position to notice most of the signs of a concussion. If you notice any signs have the athlete assessed by the athletic training staff right now. If it occurs during an away game, make sure the athlete is seen by the host schools athletic trainer if you are not traveling with a student athletic trainer.

Early Signs & Symptoms



Lack of awareness of surroundings (not sure where they are)

Nausea or Vomiting

Blank stare (perplexed facial expression)

Delayed verbal and motor response (slow to answer questions or follow instructions)

Confusion and inability to focus attention (easily distracted and can’t follow instructions)

Disorientation (going in wrong direction, unaware of time, date, place)

Slurred or incoherent speech (making incomprehensible statements)

Uncoordination (stumbling, unable to balance or walk a straight line)

Out of proportion emotions (crying, demanding to return to game or practice)

Memory deficits (asking same questions, can’t memorize things, doesn’t remember injury)

Late Signs & Symptoms

Persistent low grade headache


Poor attention and concentration

Memory dysfunction

Excessive sleepiness or easy fatigue

Irritability low frustration tolerance

Intolerance to bright light difficulty focusing vision

Intolerance to loud noise, ringing in the ears

Anxiety and depressed

No athlete should return to play while still demonstrating any signs or symptoms of concussion at rest or with exertion (i.e., exercising).