What are the risks of returning to the game/sport too early? This puts the athlete at risk for SECOND IMPACT SYNDROME, which is when he/she gets a second head injury or concussion (prior to the resolved symptoms of the first). This syndrome involves swelling in the brain, changes in the circulation of blood to the brain, elevated pressure within the cranium, and often death.
Is it safe to play the sport if you have any concussion symptoms? No, it is never safe to practice or play sport until all concussion symptoms are absent.
What is a Grade 1 (mild) Concussion? It includes confusion but no loss of memory. The athlete does not lose consciousness. If this concussion is the athlete's:
1st concussion: May play again once symptoms are absent for >20 minutes.
2nd concussion: Should not return to play for the remainder of that day.
3rd concussion: Should not play for >3 months (and then only if symptoms are absent).
What is a Grade 2 (moderate) Concussion? It includes confusion and memory loss. The athlete does not lose consciousness. If this concussion is the athlete's:
1st concussion: May not return to play until symptoms absent for >1 week.
2nd concussion: Recommended to stop playing for the season. Not safe to play again until symptoms absent for >1 month.
3rd concussion: Stop playing for the rest of the season. Next season may return to play only if symptoms are absent.
What is a Grade 3 (severe) Concussion? It includes losing consciousness. If this is the athlete's:
1st concussion: May not return to play for >1 month (but only if symptoms absent for >2 weeks).
2nd concussion: May not play the rest of the season. Recommended to never again return to play.
If you are caring for someone with a recent concussion, what should you do?
1. Do not leave him/her alone for at least 24 hours after the concussion.
2. Wake him/her up every 2 hours to ensure he/she does not have unusual symptoms.
What post-concussion symptoms merit an immediate trip to the emergency room?
1. Bloody nose/ears or watery substance coming out of nose/ears.
2. Dilated pupils or asymmetrical pupils.
3. Arm and/or leg weakness or difficulty coordinating arms and/or legs.
4. Difficulty talking.
5. Uneven/unequal facial features.
6. Swelling on or around the scalp.
7. Difficulty waking him/her up.
8. Mental changes (cannot follow directions, is not alert, loses consciousness)
9. Blurry vision.
10. Complaining of strong headache.
11. Vomiting.
12. Amnesia (losing memory).
References:
1. Brotzman SB, Wilk KE. Clinical Orthopaedic Rehabilitation, 2nd ed. Mosby: 2003. Pages 527-530: "Return to Play after a Concussion" (Brotzman SB, Costella JD, Bohling M).
2. Roos R: Guidelines for managing concussion in sports: a persistent headache. 24(2):67, 1996. "Colorado Guidelines to Return to Contact Sports after Cerebral Concussion."
