Understanding The Sports Related Concussion
Bill Murray is a world-renowned athletic trainer who won the Stanley Cup twice with the New Jersey Devils. He is a Bolt Sports Co advisor and among things will be telling you to prevent & cure injury. Read his full bio here.
Hockey season is in full swing and it’s an appropriate time to talk about a common but often misunderstood and misdiagnosed injury: Concussions.
There are a multitude of reasons why concussions are easily mismanaged but one that sticks out for me is that the science and our knowledge continues to grow and evolve. An NHL Neuropsychologist once told me “what we don’t know about concussions could fill this arena”. Even the word “concussion” has evolved for many to “mild traumatic brain injury” or “MTBI”. One of the main reasons for this rebranding effort is to educate people and encourage them to take concussions more seriously. In the not too distant past a commonly used phrase, when describing a head injury, was “he got his bell rung”. This really minimizes the seriousness of a situation; no reputable health care provider will utter this phrase today.
With improved understanding of concussions comes a much better appreciation of the seriousness of this particular injury, it’s potential long term effects, and the need to protect our youngest and most vulnerable players.
In this article I would like to discuss how to recognize the signs and symptoms of a sports related concussion and the challenges in evaluating them. Why you should continuously observe your player after they sustain a significant hit to the head, neck, or body and when is it absolutely imperative that you transport them to the nearest emergency room, without delay.
A concussion is caused by a hit to the head, face, neck, or anywhere on the body with an “impulsive” force transmitted to the head. This force causes the brain to move inside of the skull. Remember, a sports related concussion is a type of traumatic brain injury.
Concussions typically result in the rapid onset of symptoms, like dizziness, however in some cases symptoms and signs may evolve over minutes, hours, or even days.
A Grade One concussion is the most common type of injury and symptoms can include dizziness, nausea, motion sickness, blurry vision. Symptoms can last from minutes to days. The best treatment is immediately removing the player from the practice or game and complete rest. A Grade Two concussion has the same symptoms as a Grade One however the symptoms can last three days from the original injury. Persistent headaches are most common along with being highly sensitive to light and sound.
A Grade Three concussion, the most serious type of concussion is any injury that causes a loss of consciousness. For me, there is no minimum amount of time that constitutes a loss of consciousness; even if a player describes a “blackout”, for only a second or two,
I always consider this a loss of consciousness. Any loss of consciousness requires an emergency room evaluation;
Do not hesitate, do not observe and wait. Always be overly cautious; this is an injury to the brain. It’s not just about the next shift or the next period or the next game; it’s about long term quality of life.
Youth hockey coaches and parents are commonly the first persons on-site to identify a possible concussion so they should be hyper vigilant with this injury in particular. Question your player or child; you know them best. Is something not right or “off”? Even if your player denies any problems it’s always a good safety practice to hold that player for a shift or two while you continue to observe them; things can change quickly. If there is even the mildest complaint from the player or the slightest concern on your part you must remove the player. Remove them from the bench. Evaluate them further in the locker room or another quiet space. Keep them in that quiet space for the remainder of the period or game. Coaches, if you must return to your bench find someone to stay with that player. Never leave the player unattended.
During my career behind an NHL bench and on an NFL sideline I have had the unfortunate experience of observing many players sustain concussions; some more serious than others. For me, no two concussions are ever the same and never “routine” and that’s what makes this particular injury so tricky and so very serious.
I had a player a player in New Jersey who was a legitimate NHL tough guy. In the course of a game at home one night he was involved in a fight; nothing unusual. He served his penalty, returned to the bench, and was available for the remainder of the game. He never complained of anything following his fight or post-game. He presented the next morning for our regular practice and denied any symptoms as result of the previous night’s game. He completed that day’s practice without restrictions. He left the rink in his usual manner along with everyone else. Later that afternoon, about five hours later, he telephoned me in a state of complete confusion and significant panic. He was on his way home after practice, normally about a fifteen minute drive, but he never arrived; he never stopped driving all that time and only then did he realize that he was completely lost. This player became very emotional when I asked him for his location; he was scared and I was scared for him. I told him to stop his car on the shoulder of the highway and describe what he could see. He was no longer in New Jersey; he had driven many hours into and across Pennsylvania. Fortunately, the Pennsylvania State Police were able to locate him. In retrospect, this player clearly sustained a concussion the previous night. This unfortunate experience taught me to never underestimate the urgency of head and neck injuries. I hope it will have the same effect on you.
My personal motto, when it comes to head and neck injuries, is this: “When in doubt, you must holdout”.
Sticking to this rule followed immediately by a comprehensive exam and evaluation by a medical professional will keep your player safe and ensure a quality of life both on and off the ice.