Fast Facts:
The rotator cuff is made up of 4 muscles, the infraspinatus, supraspinatus, teres minor, and subscapularis.

By Jon Heck, MS, ATC
Coordinator of Athletic Trainer
3/98

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.

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 

• Headache
• Dizziness
• 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)

• Persistent low grade headache
• Lightheadedness
• 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