Concussion is a sports disorder that occurs particularly in contact sports.
Concussion is a temporary disturbance of consciousness or memory resulting from an external impact on the head (disturbance of consciousness does not necessarily mean loss of consciousness or altered consciousness). This disorder is reversible, and essentially no organic damage to the brain itself occurs. The following definitions of concussion are provided in the Safety Measures Manual of the Japan Rugby Football Union.
[Any obvious head bruise on the ground, abnormal response (state of consciousness) or any abnormality in physical activity at the time of injury falls under concussion as a rule of competition.]
Most common events
Contact sports, such as American football, rugby, boxing, ice hockey, motor biking, gymnastics, horse riding, and skiing, and sports where the head may be injured in falls are most common.
Even though the patient is conscious, headache, dizziness, tinnitus, nausea, and blurred vision may occur. More severe symptoms may be associated with memory loss (names, date of birth, address, time of injury, and subsequent questions about what to say), inability to speak, and breathing and heart rhythm irregularities. If the person has headache with disturbance of consciousness within 5 minutes, it would be severe case and evaluation by a doctor is essential. If consciousness is severely affected for more than 5 minutes, the patient should be immediately transported to the hospital. It is also important to remember that head injuries are likely to be complicated by cervical spine sprains and whiplash symptoms (neck pain and stiff shoulders).
Follow the ball behind, and immediately after catching it, the player crashed hard into the advertising fence from the back of the head. He was able to continue, even though he fell down.
After a concussion, the person must rest, and the level of consciousness, breathing, and pulse need to be checked. Then, make sure to conduct icing on the head and neck region, and check if there is paralysis of the hand and the leg even if the person isn’t unconscious. Do not give water to athletes with impaired consciousness, because they may choke after throwing up.
Return to sports
In the actual sports field, cases of mild symptoms, rather than head bruises with clear consciousness disturbance, may become problems as these would lead to make judgment of return immediately. The judgment can be made differently by the presence or absence of consciousness. The athlete can return to competition if there is no loss of consciousness (-), loss of memory (-), headache, nausea, or dizziness, and there is no imbalance in jumping or dashing. However, a person with headache, facial pallor, or agitation should be monitored without returning to competition.
Severity classification of brain concussion and index of return to sports
1. (Mild): Loss of consciousness (-), traumatic amnesia within 30 minutes → no symptom persists for a week, return to sports is allowed.
2. (Moderate): Loss of consciousness within 5 minutes and traumatic amnesia within 30 minutes → no symptom persists for a week, return to sports is allowed.
3. (Severe): Disturbance of consciousness persists more than 5 minutes and traumatic amnesia persists for 24 hours → return to competition takes at least a month.
This is a case of a 24-year-old male volleyball athlete during the international match.
He hit a relatively soft fence when was following the ball at 7:30 p.m. and he was able to continue playing without head bruising or disturbance of consciousness.
The game ended at 8:30 p.m. He continued having a headache and a feeling of discomfort after he returned to the lodgment and had dinner. He experienced sudden large-volume vomiting and a condition of stupor even though he was able to answer and open the eye (Figure, JCSI-2) around 10:30 p.m. He was taken to the hospital by ambulance and was admitted to the hospital for a follow-up. On the following day, he had a headache and neck pain even though he was awake and able to have breakfast. There was no evidence of a fracture by skull radiography. There were no obvious brain damage, bleed, or edema by CT or MRI. He was able to return to sports three days later by permission of a neurosurgical specialist, but he was eventually not able to perform satisfactorily as the headache and neck pain strongly persisted and he felt his body floated. In this case, it was difficult to determine when to return to sports after the head injury.
A study from the University of Toronto in 2004 reported negative mood disorders, such as depression and confusion, after a concussion due to a sports injury. Concussion-induced depression resolved within 7 days, confusion, and general mood disturbance resolved within 3 weeks, but emotional differences with teammates also occurred.
Classification of the degree of consciousness disorder according to the Japan Coma Scale (JCS) is divided into three grades.
1) Awake state without stimulus (expressed by one-digit) (delirium, confusion, and senselessness)
1. Awareness is lucid, but it is not quite clear at this time .
2. He/she has disorientation.
3. He/she cannot say name or date of birth.
2) Awake state when stimulated, falling asleep when stopping stimulating (expressed by two-digit) (stupor, lethargy, hypersomnia, somnolence, and drowsiness)
10. He/she can open the eye when being normally called. He/she can make purposeful movements (e.g., gripping or leaving the right hand). He/she can speak but there are some mistakes.
20. He/she can respond to a simple command to open the eye by a loud voice or shaking body, e.g., handgrip.
30. He/she can barely open the eye when adding painful stimulus and repetitive calling.
3) Not awake state when stimulated (expressed by three-digit) (deep coma, coma, and semicoma)
100. He/she tries to wave off toward painful stimuli.
200. He/she moves hands or feet slightly or frowns up his/her face toward painful stimuli.
300. He/she does not respond to painful stimuli