Editor’s
Note: This article was circulated by the Georgia Youth Soccer
Association, but as long as there are rocks and trees in and along
the rivers and streams, concussion is an issue every paddler ought to
know something about as well.

Concussion
is a controversial and tricky medical topic, but any coach or parent
who works with soccer players needs to know what to do if you are
faced with a situation in which you suspect a player has had a
concussion.

Let
me first define what a concussion is: it’s an alteration in brain
function that occurs from a direct blow to the head. If a player
takes direct contact to the head, the most common complaint after a
concussion is confusion. Other very common problems include a
short-term inability to recall events just prior and just after the
moment of contact, headache, or light-headedness. In more severe
incidents there may be loss of consciousness (the player is “knocked
out”).

There
seems to be a tendency to minimize the potential severity of a
concussion — we’ve all heard an announcer make an off-handed
comment along the lines of “wow, he got his bell rung and I bet
he’s really going to have a headache tomorrow.” Well, there is a
growing base of very solid scientific evidence that even so-called
“mild” concussions can be serious injuries.

Some
New Research on Concussions

Concussions
are probably under-reported, in that many athletes will get a very
mild concussion and not report it to the coach or trainer. One
Canadian study of youth soccer players ages 12-17 reported an amazing
48% of their athletes with symptoms of concussion at least one time
during only one season. A study of male and female soccer players in
the Atlantic Coast Conference reported about one concussion per team
per season. The “real” number of concussions is still subject to
debate.

Whether
headgear reduces the number of concussions is also controversial. The
Canadian study showed that the number of concussions was much less in
the players wearing headgear, but there are not many other studies
showing a reduction with headgear. We don’t have consensus on
headgear.

The
most interesting new facts about concussion involve gender
differences. It appears that female athletes do “worse” than
males with concussions. An excellent study from the University of
Pittsburgh showed that females reported more symptoms from
concussions, they did worse on tests of reaction times, and there was
a trend toward females doing worse on tests of memory and visual
motor skills. These trends are supported by other scientific
studies.

Findings
reported at the 2nd International Symposium on Concussion in Sport
are changing the way we treat concussions. Among their findings are
that with even simple concussions, the player should not return to
play the same day, the player should be evaluated by a physician, and
that return to play follows a stepwise process over 7 to 10 days.

What
Team Physicians Do

For
trained team physicians, we look for responsiveness if the athlete is
“down,” then we assess their airway (whether there is any
obstruction to breathing), whether they are able to breathe, and
their circulation or heartbeat (these fundamentals are known as the
“ABCs”).

I
then assess for any potential spine injury, and if it is suspected,
we properly immobilize the athlete’s spine to protect them from
injury during movement. If there is no suspicion of a spine injury
and the athlete is responsive enough to walk, we will go to the
sideline where a thorough assessment is performed.

For
me, the most critical part is being able to tell whether this is the
same athlete I’ve known in practice — are they at the baseline
I’ve come to know. There are also several tests for orientation,
memory, and concentration that we will typically perform.

What
You Should Do on Your Field

I
believe that the new evidence we have points to even “mild”
concussions as potentially serious injuries that demand great care.
With that in mind, and also given that most coaches or parents are
not medically trained, I recommend the following:

*Look
at the “ABCs” first — if you have any question, call 911
immediately.

*If
you are concerned for a spine injury, do not move the athlete, call
911.

*If
the athlete is responsive but appears to be confused, you should
suspect a concussion, remove the player from the game or practice and
DO NOT let him or her return to the game or practice that day.

*Someone
should observe the player on the sideline for symptoms of confusion,
headache, or light-headedness.

*If
those symptoms do not return to normal in 15 minutes, the player
should be transported to the nearest Emergency Room.

*For
players whose symptoms return to normal in less than 15 minutes, I
believe they should still be evaluated by a physician in the next day
or two.

(Dev
K. Mishra is an orthopedic surgeon in private practice in Burlingame,
California; Team Physician at the University of California, Berkeley;
Medical Director of the International Children’s Games and a member
of the team physician pool with the U.S. Soccer Federation. Dr.
Mishra’s website is: www.thesoccerdoc.com).

by
Dev K. Mishra, M.D.
From The Eddy Line, February 2009