It's better to miss one game than the whole season

Working in sports concussion management we often hear about an athlete who has a concussion and is returned to the same contest where a second concussion is sustained. In many of these cases the effect on the athlete is significant, sometimes devastating. The Centers for Disease Control (CDC) and others in the medical community are doing their best to educate coaches, athletic trainers, athletes and parents about the symptoms of concussion and the importance of early intervention. The most important part of that intervention is removing the athlete from the contest.

The CDC website for coaches includes the following statement: “If you think your athlete has sustained a concussion… take him/her out of play, and seek the advice of a health care professional experienced in evaluating for concussion. “ It also admonishes the coach “don’t assess it [the concussion] yourself… seek the advice of a health care professional.” Along with this advice the CDC provides lots of information and resources for coaches including posters and guidelines to help coaches recognize a concussion.

While the coaches are often in the best position to first observe the symptoms of concussion in their players, they should not be left alone with this responsibility. Other team staff, players, parents and other spectators can participate in the process of identifying the symptoms of concussion. The risk of further injury, including the rare condition referred to as second impact syndrome, make the identification of concussion crucial so that the athlete can be removed from the game until the seriousness of the symptoms can be assessed.

The CDC website also includes the following statement “It's better to miss one game than the whole season”

A Personal Experience with Concussion

In 1991 I graduated with a Ph.D., in clinical psychology with an emphasis in neuropsychology. I completed additional training in neuropsychology at the Cambridge Hospital (a training hospital for Harvard Medical School) and then at the University of Michigan Medical School. I was in my fourth year as a staff neuropsychologist at a residential brain injury facility in East Lansing when I had my first and only concussion.

I was at the Michigan Athletic Club, a sprawling recreational facility in East Lansing, where I spent several hours every day playing basketball and lifting weights. There was a regular crowd of us that played pickup basketball there daily and we all knew each other pretty well. On this particular day there were not yet enough of us to play a full game so we were messing around playing a kind of half-court free for all.

I remember jumping and reaching for a ball that was coming off the hoop when a good friend of mine got under me. As I started to fall, he tried to help me but in his effort to do so he tied up my hands so I could not use them to help break my fall. With my hip on his shoulder and my momentum going sideways I quickly pivoted and hit the back of my head on the floor with significant force. I remember a bright flash of light and some localized pain at the site of the impact. I did not lose consciousness (only about 10% of concussions involve loss of consciousness) and I remember feeling alarmed that I had hit my head with such force.

As a neuropsychologist I had seen many people whose lives had been devastated by trauma to the head and as I got up off the floor a wave of apprehension swept over me. I walked over and sat on the stairs by the court and began a kind of self-examination. I was not entirely sure what day it was, my mind felt kind of foggy, but other than that I seemed to be OK. After about 15 minutes of sitting and continuing my self-examination I walked to the locker room, gathered my belongings and went home.

As concussions go, mine was relatively minor. I had some residual fogginess through the evening, I developed a low grade headache, and I definitely did not feel as sharp mentally as I usually did. That lack of mental sharpness persisted for a couple of days, but lucky for me it was the weekend and by Monday morning I felt fine resuming my normal duties.

When I think back on this experience I am grateful that I knew enough to not put myself at further risk of injury before I was fully recovered. It is these additional injuries that occur before the initial concussion is resolved that seem to do the most severe damage.