The signs and symptoms of a concussion may be subtle and sometimes not immediately apparent. Do you know how to spot a concussion? Some early signs include, headache, dizziness, blurry vision and nausea and these signs can get worse if unattended.
Whether you are a parent, coach or athlete, this is must have information. Dr. Rosenberg shares signs, symptoms and how to care for and prevent concussions.
Selected Podcast
Spotting and Treating Concussions
Featured Speaker:
Dr. Rosenberg is a member of the American Medical Society for Sports Medicine, American Academy of Family Practice, and Society of Teachers in Family Medicine. He is the author of book chapters that are published in the most recent edition of 5-minute Sports Medicine Consult.
Jeffrey Rosenberg, MD
Before joining Summit Medical Group, Jeffrey Rosenberg, MD, was Assistant Residency Director, Founder of the Fellowship Director of Primary Sports Medicine, and Predoctoral Coordinator for Mountainside Hospital in Montclair, New Jersey. He has been Team Physician for Glen Ridge High School and West Essex High School. In addition, he has provided medical coverage as Team Captain for the New York City Marathon.Dr. Rosenberg is a member of the American Medical Society for Sports Medicine, American Academy of Family Practice, and Society of Teachers in Family Medicine. He is the author of book chapters that are published in the most recent edition of 5-minute Sports Medicine Consult.
Transcription:
Spotting and Treating Concussions
Melanie Cole (Host): The signs and symptoms of a concussion can be subtle and may not even be immediately apparent, but this is a problem that you’ve been hearing about more and more in the media, and we have to keep our athletes safe. My guest today is Dr. Jeffery Rosenberg. He’s a Primary Care Sports Medicine physician at Summit Medical Group. Welcome to the show, Dr. Rosenberg. Tell us about concussion. What’s going on in the world of concussion today? Are we seeing more of them, or are we seeing fewer?
Dr. Jeffery Rosenberg (Guest): Thanks very much for having me. I think in general that we are probably not necessarily seeing more concussions as much as people are finally recognizing them and reporting the symptoms. We have known for a long period of time that many athletes, especially contact athletes—so football players, lacrosse players, hockey players, as well as many other athletes—have had concussions for many years. In general, we’ve thought only 20 or 30 percent of them were actually reported to a physician or somebody on the sideline, and so a lot of kids would just continue to play in spite of having concussion symptoms. Over the past three to five years, we have really increased the amount of education for both parents, coaches, as well as student athletes, and we’re finally getting people to recognize the importance of reporting concussion symptoms. Yes, there are more concussions happening because there are more athletes in general. There are more concussions happening because the athletes are stronger and faster, and sports themselves are getting more intense at a younger age. But in general, I believe more we’re just hearing about the injuries that we knew were probably happening in the past but we weren’t recognizing them because nobody said they had any pain.
Melanie: Okay. So I’ve got kids in sports, and I don't want them in hockey or football or lacrosse, because the kids are big.
Dr. Rosenberg: Yes. They sure are getting bigger and bigger.
Melanie: They’re getting bigger and bigger. And as you said, the sports are getting more and more high-end and terrifying and faster and harder. Now, do we look to things like helmets? Are they getting better and better? Are they helping to protect us, or is that sort of just first-line defense and really not quite the protection we might all think they are?
Dr. Rosenberg: I think the answer’s probably both. Certainly, concussions are first-line defense against the trauma of a sport that involves head traumas. So obviously, a foot ball helmet is very important for a football athlete and player. At the very high end, such as in a professional college level, they are trying to make football helmets more absorptive so that they take more of the force and stress so that less of it is taken into the brain. Unfortunately, in spite of the best engineering ideas of let’s do this to make the impact less severe for the brain or the skull, we’ve only been able to show that head trauma and skull fractures can be prevented with good helmets, but unfortunately, concussions cannot. In addition, there’s a lot of mouth guards now being marketed to prevent forces or to prevent the risk of concussions. Again, those have been shown to prevent you from breaking your teeth, but they’ve never been shown to prevent concussions from actually occurring in the traumatic situation.
Melanie: So signs and symptoms, things that we should be on the lookout for coaches, parents on the sideline, and even the buddy system, teammates. What should we be looking for in concussion?
Dr. Rosenberg: Well, at the sideline or when an injury first happens on the field, the most common symptoms that I’ll hear reported are headaches, dizziness, blurry vision, and a sense of fogginess or grogginess. Yes, luckily, a small percentage of athletes will actually pass out or be down on the ground at the time of their concussion, but most people with a head injury involved will still be standing and will hopefully be walking back to the proper sideline or the proper huddle on the field. Once people come off the field and within the few hours of exercise, typically, the concussion symptoms will even worsen. They can include nausea, blurry vision, ringing in the ear, dizziness. Then as time progresses, once the children at home, parents may notice difficulty sleeping, either sleeping too much or not enough, problems falling sleep or staying asleep as well as the need to take a lot of daytime naps, more emotional problems such as depression or irritability, and what we call cognitive problems—so difficulties remembering things, having actual amnesia of the day of the injury or time afterwards, learning difficulties, and almost ADD-like symptoms. So, most of those concussion symptoms are involved in those four categories.
Melanie: Now, Dr. Rosenberg, every parent for time gone by looks at the eyes right away to see if the pupils are different. Is that still the way?
Dr. Rosenberg: Well, at the sideline or immediately at the time of the injury, yes. Either an athletic trainer or a physician or maybe a coach, if there’s one around that knows enough to do so, we’ll certainly do as a focal or focus in our logical exam. Looking for pupil dilation is part of that. Certainly, anybody whose pupils are already not dilating or are unequal probably don't have a concussion. They have probably a worse injury, which does need to be seen in an emergency room right away. So that is a good way to get a sense of whether something really tragic may be going on. But most people with concussions will have normal reflex exams in the eyes.
Melanie: What do we do once we get them home? We rest the child? Is there any drugs we can give them? What?
Dr. Rosenberg: Mostly I just tell the parents to give them some Tylenol and Motrin for their headaches and just to kind of reassure them. I think it’s very hard as a parent; because unlike if there’s broken bones or if there are stitches and there’s bleeding, a parent can’t do anything about a concussion. You basically want to make sure that the child doesn’t worsen in any of their symptoms, that they’re not becoming sleepier or so sleepy that they can’t wake up. That certainly is a danger sign if anything worsens. So watching them over the first 24 hours is really important. That idea of waking them up every two hours to see if they’re okay, we’ve kind of thrown that idea out of the way because basically, what happens is then you wake up every two hours, you wake up the child every two hours, and the next day everybody’s really tired and even more miserable because they’re just tired, not because of the concussion themselves. So having to check up on them and waking them up in the middle of the night is not necessary. Certainly, eyeballing them before you go to sleep and making sure that they’re breathing normally and that they seem okay from a sleeping perspective is okay, but I don't recommend waking them up anymore to make sure they’re okay.
Melanie: What about mental concentration activities? Much as they hate that, we might not have to let them play video games.
Dr. Rosenberg: Yes, depending on how people feel when I see them in the office a few days after concussion, certainly almost complete rest from all of those activities is useful for a day or two. If I’ll see somebody early the next week on a Monday or Tuesday, if they’re still having difficulties, I will often keep them out of school. Certainly, there should be no TVs, video games, loud noises. I tell the kids to go in the corner and watch the grass grow or the fish around the fish tank. That’s torturous for everybody, but that’s the best way to let your brain rest, and that’s what you need. Just like if you sprain your knee and you wouldn’t want to run around on it and you wouldn’t want to stress it, you really just have to let your brain rest for a few days. Seventy to 80 percent of concussions are better in five to seven days, so most people do fine. You just need to give them a chance to rest. Turning them back into school on Monday, letting them play on their phones all day or play video games is just going to irritate their brain more and actually make them feel much worse.
Melanie: Very quickly, when can they return to play?
Dr. Rosenberg: Student athletes have to be completely asymptomatic, so they have to feel totally fine in every way before they’re released to do anything. I want a kid to be back at school at least after a day or two to make sure that they can get through and function on a normal day to day school. Many states now have state mandated to return to play programs, where basically it’s a three- to five-day process of slowly increasing the amount of activity and physical exertion that you do as long as you do okay from that and don't get a headache or worsening symptoms and you continue to feel well that night and the next day, then you progress through that program. Once you’ve hit usually the fifth day, you’re back at practice. If there’s no problems, then you go back in the field. So, most concussions in most high school and college athletes are anywhere from one or two weeks of missing his time doing sports. The reason why we do this is if you get another concussion before you’re over the first one, you can have a fatalresponse, which is called second-impact syndrome, that can basically affect your brain function to the point that it can kill you or put you in a coma. That’s the severest thing that we’re really here to protect at this point. Obviously, at the very high end, the college or pro-level, these are older athletes that are being a lot of money to play their sport. They don't typically get this severe second-impact syndrome, and so it’s safer to return them to play as long as they are actually feeling normal. They won’t die from it. They’ll just feel worse if they get another concussion. A 12- or 15-year-old kid, if you have another concussion while you’re not better from the first, could be a really fatal event. It’s something that we all want to prevent as much as we can.
Melanie: And in the last 30 to 40 seconds or so, your best advice for preventing concussion in our athletes.
Dr. Rosenberg: That’s a tough one. I think that from a prevention perspective, making sure you are wearing your proper equipment and making sure that you tackle appropriately if you’re playing football. If this is hockey or lacrosse, there’s something where there’s a board around. Don't give people cheap shot. Don’t hit them with a stick in their head. Don't purposely traumatize somebody, because in spite of your anger and the feeling of wanting to maybe get them for them doing something to you, you really don't want to cause somebody to have a fatal head injury. You won’t feel well about yourself in the morning. So prevention is the key just so that you don’t do something silly that you may wish didn’t happen later on down the road.
Melanie: Well, that certainly is the message. Prevention is the key. You’re listening to Summit Medical Group Radio. For more information, you can go to summitmedicalgroup.com. This is Melanie Cole. Thanks for listening.
Spotting and Treating Concussions
Melanie Cole (Host): The signs and symptoms of a concussion can be subtle and may not even be immediately apparent, but this is a problem that you’ve been hearing about more and more in the media, and we have to keep our athletes safe. My guest today is Dr. Jeffery Rosenberg. He’s a Primary Care Sports Medicine physician at Summit Medical Group. Welcome to the show, Dr. Rosenberg. Tell us about concussion. What’s going on in the world of concussion today? Are we seeing more of them, or are we seeing fewer?
Dr. Jeffery Rosenberg (Guest): Thanks very much for having me. I think in general that we are probably not necessarily seeing more concussions as much as people are finally recognizing them and reporting the symptoms. We have known for a long period of time that many athletes, especially contact athletes—so football players, lacrosse players, hockey players, as well as many other athletes—have had concussions for many years. In general, we’ve thought only 20 or 30 percent of them were actually reported to a physician or somebody on the sideline, and so a lot of kids would just continue to play in spite of having concussion symptoms. Over the past three to five years, we have really increased the amount of education for both parents, coaches, as well as student athletes, and we’re finally getting people to recognize the importance of reporting concussion symptoms. Yes, there are more concussions happening because there are more athletes in general. There are more concussions happening because the athletes are stronger and faster, and sports themselves are getting more intense at a younger age. But in general, I believe more we’re just hearing about the injuries that we knew were probably happening in the past but we weren’t recognizing them because nobody said they had any pain.
Melanie: Okay. So I’ve got kids in sports, and I don't want them in hockey or football or lacrosse, because the kids are big.
Dr. Rosenberg: Yes. They sure are getting bigger and bigger.
Melanie: They’re getting bigger and bigger. And as you said, the sports are getting more and more high-end and terrifying and faster and harder. Now, do we look to things like helmets? Are they getting better and better? Are they helping to protect us, or is that sort of just first-line defense and really not quite the protection we might all think they are?
Dr. Rosenberg: I think the answer’s probably both. Certainly, concussions are first-line defense against the trauma of a sport that involves head traumas. So obviously, a foot ball helmet is very important for a football athlete and player. At the very high end, such as in a professional college level, they are trying to make football helmets more absorptive so that they take more of the force and stress so that less of it is taken into the brain. Unfortunately, in spite of the best engineering ideas of let’s do this to make the impact less severe for the brain or the skull, we’ve only been able to show that head trauma and skull fractures can be prevented with good helmets, but unfortunately, concussions cannot. In addition, there’s a lot of mouth guards now being marketed to prevent forces or to prevent the risk of concussions. Again, those have been shown to prevent you from breaking your teeth, but they’ve never been shown to prevent concussions from actually occurring in the traumatic situation.
Melanie: So signs and symptoms, things that we should be on the lookout for coaches, parents on the sideline, and even the buddy system, teammates. What should we be looking for in concussion?
Dr. Rosenberg: Well, at the sideline or when an injury first happens on the field, the most common symptoms that I’ll hear reported are headaches, dizziness, blurry vision, and a sense of fogginess or grogginess. Yes, luckily, a small percentage of athletes will actually pass out or be down on the ground at the time of their concussion, but most people with a head injury involved will still be standing and will hopefully be walking back to the proper sideline or the proper huddle on the field. Once people come off the field and within the few hours of exercise, typically, the concussion symptoms will even worsen. They can include nausea, blurry vision, ringing in the ear, dizziness. Then as time progresses, once the children at home, parents may notice difficulty sleeping, either sleeping too much or not enough, problems falling sleep or staying asleep as well as the need to take a lot of daytime naps, more emotional problems such as depression or irritability, and what we call cognitive problems—so difficulties remembering things, having actual amnesia of the day of the injury or time afterwards, learning difficulties, and almost ADD-like symptoms. So, most of those concussion symptoms are involved in those four categories.
Melanie: Now, Dr. Rosenberg, every parent for time gone by looks at the eyes right away to see if the pupils are different. Is that still the way?
Dr. Rosenberg: Well, at the sideline or immediately at the time of the injury, yes. Either an athletic trainer or a physician or maybe a coach, if there’s one around that knows enough to do so, we’ll certainly do as a focal or focus in our logical exam. Looking for pupil dilation is part of that. Certainly, anybody whose pupils are already not dilating or are unequal probably don't have a concussion. They have probably a worse injury, which does need to be seen in an emergency room right away. So that is a good way to get a sense of whether something really tragic may be going on. But most people with concussions will have normal reflex exams in the eyes.
Melanie: What do we do once we get them home? We rest the child? Is there any drugs we can give them? What?
Dr. Rosenberg: Mostly I just tell the parents to give them some Tylenol and Motrin for their headaches and just to kind of reassure them. I think it’s very hard as a parent; because unlike if there’s broken bones or if there are stitches and there’s bleeding, a parent can’t do anything about a concussion. You basically want to make sure that the child doesn’t worsen in any of their symptoms, that they’re not becoming sleepier or so sleepy that they can’t wake up. That certainly is a danger sign if anything worsens. So watching them over the first 24 hours is really important. That idea of waking them up every two hours to see if they’re okay, we’ve kind of thrown that idea out of the way because basically, what happens is then you wake up every two hours, you wake up the child every two hours, and the next day everybody’s really tired and even more miserable because they’re just tired, not because of the concussion themselves. So having to check up on them and waking them up in the middle of the night is not necessary. Certainly, eyeballing them before you go to sleep and making sure that they’re breathing normally and that they seem okay from a sleeping perspective is okay, but I don't recommend waking them up anymore to make sure they’re okay.
Melanie: What about mental concentration activities? Much as they hate that, we might not have to let them play video games.
Dr. Rosenberg: Yes, depending on how people feel when I see them in the office a few days after concussion, certainly almost complete rest from all of those activities is useful for a day or two. If I’ll see somebody early the next week on a Monday or Tuesday, if they’re still having difficulties, I will often keep them out of school. Certainly, there should be no TVs, video games, loud noises. I tell the kids to go in the corner and watch the grass grow or the fish around the fish tank. That’s torturous for everybody, but that’s the best way to let your brain rest, and that’s what you need. Just like if you sprain your knee and you wouldn’t want to run around on it and you wouldn’t want to stress it, you really just have to let your brain rest for a few days. Seventy to 80 percent of concussions are better in five to seven days, so most people do fine. You just need to give them a chance to rest. Turning them back into school on Monday, letting them play on their phones all day or play video games is just going to irritate their brain more and actually make them feel much worse.
Melanie: Very quickly, when can they return to play?
Dr. Rosenberg: Student athletes have to be completely asymptomatic, so they have to feel totally fine in every way before they’re released to do anything. I want a kid to be back at school at least after a day or two to make sure that they can get through and function on a normal day to day school. Many states now have state mandated to return to play programs, where basically it’s a three- to five-day process of slowly increasing the amount of activity and physical exertion that you do as long as you do okay from that and don't get a headache or worsening symptoms and you continue to feel well that night and the next day, then you progress through that program. Once you’ve hit usually the fifth day, you’re back at practice. If there’s no problems, then you go back in the field. So, most concussions in most high school and college athletes are anywhere from one or two weeks of missing his time doing sports. The reason why we do this is if you get another concussion before you’re over the first one, you can have a fatalresponse, which is called second-impact syndrome, that can basically affect your brain function to the point that it can kill you or put you in a coma. That’s the severest thing that we’re really here to protect at this point. Obviously, at the very high end, the college or pro-level, these are older athletes that are being a lot of money to play their sport. They don't typically get this severe second-impact syndrome, and so it’s safer to return them to play as long as they are actually feeling normal. They won’t die from it. They’ll just feel worse if they get another concussion. A 12- or 15-year-old kid, if you have another concussion while you’re not better from the first, could be a really fatal event. It’s something that we all want to prevent as much as we can.
Melanie: And in the last 30 to 40 seconds or so, your best advice for preventing concussion in our athletes.
Dr. Rosenberg: That’s a tough one. I think that from a prevention perspective, making sure you are wearing your proper equipment and making sure that you tackle appropriately if you’re playing football. If this is hockey or lacrosse, there’s something where there’s a board around. Don't give people cheap shot. Don’t hit them with a stick in their head. Don't purposely traumatize somebody, because in spite of your anger and the feeling of wanting to maybe get them for them doing something to you, you really don't want to cause somebody to have a fatal head injury. You won’t feel well about yourself in the morning. So prevention is the key just so that you don’t do something silly that you may wish didn’t happen later on down the road.
Melanie: Well, that certainly is the message. Prevention is the key. You’re listening to Summit Medical Group Radio. For more information, you can go to summitmedicalgroup.com. This is Melanie Cole. Thanks for listening.