Sport Related Concussion and Head Injuries

Guidelines For Parents And Athletes

  • Head injuries are among the most serious types of injuries that occur among athletes. Fortunately, serious injuries are rare.
  • Careful attention to any head injury by parents, coaches, and medical professionals can help prevent complications from developing.
  • Skull fractures are uncommon and are unrelated to brain damage or concussion. Brain damage from head injuries is uncommon in sports.
  • After any significant head injury, the athlete should NOT be left alone and for the first 24 hours should be awakened every 2-3 hours during sleep to be checked.


  • 20% of the 1.5 million head injuries that occur in the United States each year are sports-related.
  • Approximately one tenth of sports-related injuries require hospitalization.
  • 20% of high school football players and 40% of college football players will get a head injury at some point in their career.
  • Those who have had a head injury are at 2 to 4 times greater risk of having another.
  • Sports most likely to result in concussion: boxing, field hockey, football, ice hockey, lacrosse, martial arts, rodeo, soccer, and wrestling.


Concussion refers to a head injury in which there is bruising of the brain, but not permanent damage or bleeding. It may occur with or without loss of consciousness.

Common symptoms include:

  • Confusion
  • Headache
  • Nausea
  • Vomiting
  • Dizziness
  • Unsteadiness
  • Feeling "in a fog"

Grading of Concussions - American Academy of Neurology

Grade I: confusion lasting <15 minutes without loss of consciousness: may return to play if all symptoms clear completely and athlete has normal sideline evaluation during rest and exertion after 30 minutes

Grade II: confusion lasting >15 minutes without loss of consciousness: may play after 1 week if all symptoms clear completely

Grade III: loss of consciousness, even for seconds: may play after 1 month if all symptoms clear completely

Confusion Is Present If Any Of The Following Are Affected

Test for attention:

  • Ask athlete to repeat a series of numbers forward and backward and name the months backward.
  • Most high school athletes should be able to repeat about 7 numbers forward and five numbers backward two out of three times.

Test for amnesia: Ask the athlete the following:

  • name of the opponent
  • score of the game
  • period or quarter that injury occurred in
  • sequence of events that preceded the injury

Test for mental status: Ask the athlete the following:

  • What he/she did prior to game
  • Time, date, home address and phone number
  • Ask child to memorize and minutes later to recall three to five words (immediate recall memory)

What To Watch For After A Head Injury

Normal signs in the first 2 days include:

  • Fatigue and desire for extra sleep (but can be easily awakened during sleep)
  • Headache (should be fairly mild and not worsening)
  • Nausea and vomiting (occasional - not persistent)
  • Problems with thinking, concentration, and attention span (this may persist for up to a year or more)

Signs that suggest the need for immediate medical attention include:

  • Marked change in personality--often with confusion and irritability
  • Worsening headache, especially if associated with nausea or vomiting
  • Numbness, tingling, or weakness in the arms or legs, changes in breathing pattern, or seizure
  • Eye and vision changes (double vision, blurred vision, unequal-sized pupils)

Preventing Head Injuries

  • Understand grades of concussions and follow "return to play" guidelines above.
  • A player with symptoms should never be permitted to return to play!
  • Insist on the best possible equipment (especially properly fitted head gear) and WEAR IT!
  • Always follow safe sports techniques and avoid risks: no head-down tackling (spearing); no diving into water of unknown depth; use care during gymnastic routines; avoid use of trampolines; wear a helmet for all biking and street skating.
  • Follow-up with your pediatrician after ANY head injury.

American Academy of Pediatrics, Section on Sports Medicine and Fitness


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