Head Injuries

Head injuries are common in sports in which adolescents participate. Although head injuries are most common in football, the following sports are most likely to result in head injury.

• Boxing
• Field hockey
• Football
• Gymnastics
• Ice hockey
• Lacrosse
• Martial arts
• Rodeo
• Soccer
• Wrestling

There are three mechanisms that produce head injury in sports. A strong blow to an athlete’s stationary head, such as a left hook in boxing, produces maximal brain injury beneath the point of injury. If an athlete’s head is moving, then damage occurs opposite the site of the head impact. A skull fracture may produce direct injury to the brain underneath the fracture point.

Head injuries are classified as major or minor although some authorities disagree as to whether any head injury is minor since there is some evidence that the teen with a head injury may have a reduction in his or her ability to process new information. And repeated head injuries may lead to intellectual impairment. Some studies suggest that the deficit from repeated head injuries may be cumulative as may be seen in the “punch drunk” boxer.

Minor head injuries encompass the concussion. There is no universal definition of concussion. Some authorities define concussion in reference to immediate and temporary post injury impairment of a neurological function such as a disturbance in the level of consciousness, balance or vision. Others define concussion based on the duration of unconsciousness. Mild or grade one concussions account for ninety percent of concussions. There is no loss of consciousness, but the athlete may have difficulty remembering events for up to thirty minutes after the injury. Termed a “ding” by some athletes and coaches, many of this type of concussion may be overlooked by the athlete or the coach.

A grade two concussion is usually associated with loss of consciousness for less than five minutes and difficulty remembering events for at least thirty minutes but less than twenty-four hours after the injury. And a grade three or severe concussion is defined as an event where there is more than a five minute period of unconsciousness, and more than twenty-four hours of post injury amnesia. Coaching staff should easily recognize grade two and grade three concussions.

Immediate medical attention is advised for teens with grade two and grade three concussions usually with transport to a medical setting. For those athletes with a grade one concussion, some are allowed to return to play after an observation period if there are no symptoms; however if symptoms persist, then medical care should be obtained. In general, adolescents with a grade one concussion are removed from the contest.

More significant or catastrophic head injuries can occur during athletics. Bleeding may occur between the skull and the brain or in the brain itself as a result of head injury. For example, a basketball player hit in the temple by the ball could develop bleeding between the skull and brain called an epidural hematoma. This injury can develop within fifteen or twenty minutes and be tragic. Bleeding deep inside the brain can be associated with a severe blow to the head as tragically occurs in boxing. Typically the athlete does not regain consciousness.

There are no hard and fast rules as to when an adolescent athlete may return to competition after a concussion. Although in a few cases, an athlete who sustains a grade one concussion and then quickly returns to normal may reenter the contest, most should sit out the game. If the athlete has no further symptoms, return to competition may occur in a week. Some authorities recommend if an athlete has a second grade one concussion during the same season, then he or she should be withheld from competition for at least two weeks assuming the athlete is free of symptoms for at least one week. For grade two and grade three concussions, the athlete may not return to sports for more prolonged periods of time. For example, the adolescent athlete who has sustained a grade three concussion must be held out of competition for at least one month.

The second impact syndrome is a serious and catastrophic but fortunately very rare event for adolescents. In this injury, the teen dies or suffers permanent brain damage after a head injury that occurs while the brain cells are still injured from a previous head injury. The first injury and the second injury could be as mild as a grade one concussion. It is not clear why certain individuals are susceptible to second impact syndrome, but there is evidence that the brains of younger athletes are more susceptible than older athletes. Staying away from competition for a week after a grade one concussion may help to prevent second impact syndrome.

Some athletes develop post-concussion syndrome after the initial concussion. Symptoms consist of headache especially upon exertion, dizziness, fatigue, irritability and some impairment of concentration and memory. Teens with these symptoms should seek medical care, and should not be allowed back into competition. And some athletes may have impairment in the rapid processing and recollection of new information. This could impact on the functioning of certain positions such as the quarterback on a football team.

Head injuries during sports may be prevented by using appropriate headgear that is properly fitted and in good repair. Rules need to be enforced against dangerous practices such as spearing, butt blocking and face and head tackling in football. In ice hockey, athletes sensing an impending crash with the boards should remember the slogan: Heads up, don’t duck that is promoted to prevent catastrophic head and cervical spine injury. Heading the ball in soccer may be associated with impairment in certain intellectual functions including memory and planning. Teens should use protective headgear in noncontact sports associated with concussion including bicycling, skateboarding, rollerblading and snowboarding. And teens should not participate in organized or unorganized boxing competitions.

It is also important the coaches and other youth athletic officials be cognizant of the recognition and treatment of head injuries. Since some coaches are parents, then a continued aggressive educational effort must be aimed at trainers, coaches and those parents who participate in adolescent athletic programs. All of these individuals should also understand when it is safe for the adolescent athlete to return to competition. And parents too must be willing to enforce the rules about when a teen may return to competition after head injury.

Related topics:

Accidents, athletic equipment, athletic injuries, bicycle safety, sports