By Jon Heck, MS, ATC
Coordinator of Athletic Trainer
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.
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 athleteís 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.
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:
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. (Our
current approach is viewable here.)
- 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
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
Note in the Concussion Guidelines that three grade 1 concussions
during a single season terminates that athleteís 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.
Late Signs &
- 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 canít follow instructions)
- Disorientation (going in wrong direction, unaware of time,
- Slurred or incoherent speech (making incomprehensible statements)
- Uncoordination (stumbling, unable to balance or walk a straight
- Out of proportion emotions (crying, demanding to return to
game or practice)
- Memory deficits (asking same questions, canít memorize things,
doesnít remember injury)
No athlete should return to play while
still demonstrating any signs or symptoms of concussion at
rest or with exertion (i.e., exercising).
- 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