ON-FIELD CONCUSSION EVALUATION
It is important to monitor the injured player every five minutes because neurological signs and symptoms can evolve over time. These guidelines can be used to assess an injured player:
- Appears dazed, confused about assignment, unsure of game, score or opponent. Ask them, who is the opposing team? What field is this? Who scored last?
- Can’t recall events after the hit or fall. Ask the injured athlete to repeat these three words: Girl, Dog, Green
- Can’t recall events before the hit or fall. Ask them, do you remember getting hit? What happened just before the hit?
- Ask the injured athlete to repeat the days of the week backwards, starting with today.
- Ask the injured athlete to repeat the three words from earlier: Girl, Dog, Green
If the player shows any of these signs and symptoms, he or she should be removed from the game, continuously monitored, and seen by a qualified physician.
In soccer, heading the ball is just part of the game, but unfortunately, it is also a common cause of concussion injury. Head injuries occur in other ways on the soccer field – colliding with other players, getting kicked in the head or chin, falling down or even stopping too abruptly.
The long-term effect of concussions has been a hot topic of debate in the sports community since the 2009 release of a posthumous study of NFL athletes’ brains by the Center for the Study of Traumatic Encephalopathy at Boston University School of Medicine. The study showed that damage to brain tissue caused by multiple concussions is systemic throughout the brain and similar to late-stage Alzheimer’s.
Sports medicine physicians encourage using pre-season baseline computerized testing, a cognitive function test which measures the accuracy and speed with which a healthy athlete answers certain questions. The results are used for comparison in case of injury. Baseline Testing is now required in most professional sports, and is strongly encouraged at the high school sports level as well.
William Jones, M.D., a sports medicine-trained, physical medicine and rehabilitation physician affiliated with the IRONMAN Sports Medicine Institute at Memorial Hermann and The University of Texas Medical School at Houston, agrees. "Concussions cause functional abnormalities, not structural abnormalities. Baseline computerized testing provides objective cognitive data to evaluate how an athlete is being affected by concussion," he says.
What is a concussion?
The human anatomy is built to protect the brain from everyday bumps and jolts. Cerebrospinal fluid, which has the consistency of gelatin, provides a natural cushion for the brain. In concussion – both mild and severe – the brain violently bounces off the inside of the skull with a force that can cause bleeding, bruising or tearing of nerve fibers.
Dr. Jones believes no concussion should be taken lightly, and that no two concussions are the same. "The athlete might seem fine one minute, and then suddenly take a rapid turn for the worse. It is important to seek qualified medical attention, and treat every head injury as unique and potentially serious."
Signs and Symptoms
The fallen player may appear dazed, move clumsily and be confused or slow to answer simple memory questions. In severe cases there may be a worsening headache, seizures, vomiting, unequal pupil dilation, neck pain or loss of consciousness.
Any athlete showing one or more signs or symptoms of concussion should be removed from play for the rest of the day and should immediately see a physician trained in treating concussions. The physician will monitor the patient and conduct a return-to-play assessment before release.
An athlete should be taken to the emergency center if he exhibits serious symptoms that include headache, seizures, focal neurological signs (unequal pupil size), drowsiness, repeated vomiting, slurred speech, inability to recognize people or places, confusion, irritability, weakness, numbness in arms or legs, neck pain, unusual behavior, and/or loss of consciousness lasting 30 seconds or longer.
Dr. Jones stresses the need for mental as well as physical rest after concussion. "The brain needs rest after a concussion. That means no video games, no text messaging and no long phone conversations. It’s not easy for a young athlete, but quiet rest is extremely important to healing after head injury."
Athletes are always tempted, and often encouraged, to "play through the pain." But with a concussion injury, returning to play too soon can cause far-reaching damage to the brain that can end a young athlete’s career in its tracks.