One hit may be all it takes for concussion

Valley athletic teams become more aware of concussions

By Gina Morton

It doesn’t take a hard hit for a Valley football player to suffer a concussion, a sports medicine physician at Geisinger Medical Center said Wednesday in the wake of recent head injuries to high-profile NFL quarterbacks.

“A misconception is you need to be knocked out, but you don’t need a loss of consciousness,” said Dr. Matthew McElroy, sports medicine physician at the Danville hospital. “Just some form of contact or hit.”

Pittsburgh’s Ben Roethlisberger and Arizona’s Kurt Warner, who battled in Super Bowl XLIII in February, both missed last Sunday’s games because of concussions.

Valley high schools and colleges are taking many preventive steps for recurring concussions — or injuries to the brain — among athletes, and are performing tests before the start of seasons to better determine the severity and necessary rest time for head injuries.

Coaches and athletic trainers may be seeing more concussions this season because athletes are more willing to acknowledge the symptoms they are experiencing, McElroy said.

“They have a better indication of what a concussion is with all the press concussions received,” he said. “Some kids are more scared and willing to admit when they get symptoms.”

Mark Keppler, head athletic trainer at Bucknell University, said the football team this season has experienced about 10 to 12 concussions, which is an average amount.

Susquehanna University’s head athletic trainer, Mike Keeney, declined to discuss the number of concussions suffered by football players this season, but said it was the average amount as in any year.

“I don’t think there were more,” he said. “I think people are more aware, much more tuned in. But it’s really been consistent in the years.”

Numbers seem consistent at high school levels as well, according to school officials.

Mike Elder, Shikellamy High School’s athletic trainer, said this season the school has seen about seven to 10 concussions with the varsity football team. This is a fairly average amount for the season.

“I can’t say it’s more than before,” said Elder, who has been the school’s trainer for 10 years. “I think it’s more recognizable. More kids are saying when they have a headache, blurred vision, trouble remembering a play that was done. There are more bellringers.”

Danville High School’s athletic trainer and Geisinger Sports Medicine employee, Brian Craven, said the football team often experiences about five concussions.



It’s like “a computer crashing”

A concussion is an injury to the brain as a result of a hard blow.

“The best analogy is a computer crashing,” Bucknell’s Keppler said. “For a period of time, the computer has to reboot and go through its systems check in order for it to come back online to be fully operational. The body does the same thing.”

Before a season begins, all schools polled said their students undergo an impact test, or test of cognitive functioning, that monitors and evaluates motor functions, memory, hand-eye coordinator, among others. If a concussion is incurred, the impact test is redone and compared to the baseline reading.

“A concussion is totally individualized to the person,” Geisinger’s Craven said, noting they are often more difficult to diagnose. “... It’s not like a bone sticking out. It’s something you can’t necessarily see.”

Shikellamy and Danville high schools, as well as Susquehanna and Bucknell universities, performs impact testing to all the athletes involved in collision sports, which includes football, soccer, basketball, field hockey and wrestling. The test is taken again and compared to the original if a student experiences a concussion.

“As the athletic trainer, I’m one of the first to see athletes coming off the field,” Shikellamy’s Elder said. “There are an array of signs and symptoms.”

Some signs of a concussion include headache, loss of consciousness, disorientation, confusion, vomiting, lack of balance, blurred vision, loss of memory or fatigue.

Trainers on the sideline are then able to do evaluations using various tests and methods to determine the level of the concussion the athlete has. Some of these injuries can clear up within minutes, others can last days or even months.

Aside from impact testing, Bucknell performs further tests to athletes who are injured at the suggestion of their medical team.

Keppler said at the referral of Geisinger, the university uses a tool named the Sport Concussion Assessment Tool, or SCAT card, which evaluates the athlete off the field to look for signs of a brain injury. Their memory is then observed by several basic questions asked and several other questions and memory questions for an athlete to recite.

“Basically we’re looking for cognitive assessment and how the brain is processing information,” Keppler said.



A concussion. Now what?

Once it is determined by trainers or medical professionals that an athlete has experienced a concussion, the amount of time for a student to be kept out of the game and any practice is determined by the severity and time length of symptoms.

“Simply put, you can have a mild bump to the arm with bruising or a contusion with a hematoma,” Keppler said. “The same is true with the brain. ... It’s hard for us to assess what’s going on.”

Susquehanna’s Keeney said an athlete’s time out of playing varies on symptoms and classification of the concussion, depending whether it is mild, moderate or severe. The decision is up to the athletic trainer and team physician.

“The bottom line is, as long as someone is exhibiting symptoms, they don’t play,” he said. “Usually the starting line with a moderate concussion is a week symptom-free before they may return to play.”

Student-athletes are pulled aside and kept out of the game for a period of time so officials can monitor the routine symptoms.

If it’s blatantly obvious the student has a concussion, Geisinger’s Craven said the athlete will be sent to a doctor for further examination. If it is minor symptoms, the student would be monitored for a period of time to make sure no additional symptoms evolve.

Once an individual has a concussion, it is likely for him to suffer another.

“It’s like building blocks,” Craven said. “They stack up on one another. They’re more likely to get another once they’ve had one.”



The road back

Elder and other trainers works alongside a team doctor from Geisinger Medical Center.

“The return to play protocol is once (the student) is symptom free, we start the physical activity gradually,” he said. “When there are no signs or symptoms, we might start them on a stationary bike.”

If the signs do not return, the student would then go a step further the next day and do a different exercise, such as a possible speed workout. If the signs remain clear, the athlete would continue to gradually move to the next step. If signs would return, the student would backstep and slow down again.

“It eases them back into physical activity without throwing them back into practice,” Elder said.

Athletes rest until they are asymptomatic, or showing no symptoms, for a 24-hour period.

“Some concussions resolve in the first seven days,” said McElroy, the Geisinger physician. “Small percent are longer than that to heal, some never go away.”

Football is the No. 1 sport in which brain injuries occur, McElroy said. Other high risk sports include soccer, field hockey, lacrosse, wrestling, even diving. Anything with contact, he said.



Don’t ignore the symptoms

Medical officials and athletic trainers all agree that concussions are not to be ignored, nor are the signs that there may be something wrong.

“It’s a pretty involved process as far as diagnosing and treating,” Susquehanna’s Keeney said. “The sports medicine team is involved, coaches, players, the athletic department. Everyone is part of a team process. We look at signs and symptoms, evaluate their progress and look at them everyday.”

McElroy said the thing that needs most progress is for coaches and athletes to be aware to not ignore symptoms.

“It’s a sign of serious illness,” he said. “The most important thing to do is let someone know what’s going on.”

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