We've all been reading about the pro athletes who've had concussions recently, how these injuries have ended careers, and shattered lives. 

(Here's a story on CTV.ca about the NHL's Sidney Crosby's recent concussion)

In a series of articles, I’m going to explore the basics of concussion, diagnosing and treating concussion, and perhaps most importantly, how to prevent concussions.

A concussion is a brain injury.  In the old days, we used to use terms like “getting your bell rung” or “seeing stars” as synonyms for a concussion.  We didn’t make much of concussions, thinking they were just part of the game, and if there was no “serious” injury, then no harm done.  We were wrong.

Some experts are advocating that we drop the term concussion altogether, and actually use the term “brain injury” instead.

We used to consider a concussion “bad” if someone lost consciousness.  But that concept has also gone out the window.  The most recent consensus conference on the diagnosis and treatment of concussion, held in Zurich in 2008, describes the fact that any concussion can be severe.

Catastrophic head injuries can lead to obvious signs of injury: weakness of the face, arm or leg, or slurred speech, loss of balance, or loss of consciousness.  The problem with concussion is that sometimes there is no clear outward sign of injury.

It used to be that we graded concussions I, II and III, depending on severity of symptoms and whether or not the athlete loses consciousness.  In this grading, a “mild” concussion might then mean an athlete would be returned to the field of play after 15 or 20 minutes.

But nowadays, we recognize that any concussion can lead to severe consequences, and that type of grading system has been thrown out.

The most important issue is that of deciding when an athlete is allowed to keep playing.

In professional sports, there is great pressure to return an athlete to play, particularly when shortly after the concussion occurs, they do not complain of any symptoms.  My rule of thumb is this:

If a concussion is suspected, do not return the athlete to competition that same day.

In particular, with young athletes, the experts at the Zurich conference agreed:

“It is not appropriate for a child or adolescent athlete with concussion to return to play on the same day as the injury regardless of the level of athletic performance.”

The main reason for this is second impact syndrome.  In this rare event, in which a brain that has already been injured is subjected to a second hit, the brain undergoes a catastrophic reaction, in which blood flows rapidly into the brain and skull, increasing pressure inside the skull to the point where the brain ceases to function.  Second impact syndrome is generally fatal.

In fact, last week Nebraska senator Steve Lathrop introduced a bill which would make it mandatory for private and public high schools, as well as other youth sports organizations, to provide coaches with training on how to recognize concussions.  There are many other states which have adopted or are introducing some legislation concerning concussions. 

But there are no similar laws in any of the provinces or territories of Canada.  Can’t we do better?