Concussion Update: The Controversy Continues

By: Dale J. Buchberger, PT, DC, CSCS, DACBSP

The High School, NCAA and NFL football seasons are approximately 3 weeks old and in the NFL alone there are 17 reported concussions. In April 2012, I wrote a previous article for The Citizen regarding concussion for parents and athletes. Given the severity and importance of the topic I feel compelled to write about recent updates in the science of concussion injury, management, and outcomes. Once again I will reference the International Conference on Concussion in Sport. The most recent conference was held in Zurich during November 2012. The preceding’s were published in the Clinical Journal of Sports Medicine in March 2013.

The Zurich statement defines concussion as, “a complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces.” It should be kept in mind that concussion is a subset of traumatic brain injury (TBI). This definition omits the need for a direct blow to the head. In an era where we have become dependent on technology such as MRI for most medical diagnosis, the Zurich statement states that imaging techniques such as MRI or CT scan are not used to diagnose concussion as much as they are used to diagnose intracerebral bleeding or injury. In other words, if the MRI of your son or daughter’s brain is normal, it does not mean they don’t have a concussion. On the contrary, it means they may have a concussion but they don’t have a more severe intracerebral injury. The corner stone of concussion diagnosis remains a detailed history and a physical examination performed by a professional who is knowledgeable in the current principles of sport related traumatic brain injury.

One of the biggest misconceptions in the area of concussion is that there needs to be direct contact to the head in order to suffer a concussion. Because the brain floats inside the skull, a severe whiplash type motion that causes the brain to impact the inside of the skull can result in a concussion. When a concussion occurs without direct impact it is often undiagnosed for a period of time following the initial onset of symptoms. Parents and coaches should understand that TBI is not a game, and no game is worth a brain. If an athlete in any sport displays symptoms of a concussion such as headache, feeling like they are in a fog, emotional symptoms, physical signs such as loss of consciousness or amnesia, behavioral changes such as irritability, cognitive impairment like slowed reaction times and/or sleep disturbances, they should be evaluated with a Sport Concussion Assessment Tool 3 (SCAT3) or a child SCAT3 if they are between the ages of 5 and 12 years old. If your child has not been assessed using the SCAT3 instrument you should ask why.

Parents and athletes should also realize that no matter how expensive or high tech a football helmet is, the helmet cannot prevent a concussion. A football helmet does a very good job of preventing facial injury and skull fracture but as long as the brain moves inside the skull, it won’t prevent a concussion.

Keep in mind that adolescents take longer to recover from a concussion than adults. The developing brain requires more energy to function and heal. After a concussion, the physiological mechanisms that take place reduce circulation to the brain and thus the energy supply cannot keep up with the energy demand. This results in slower recovery. Don’t rush an adolescent athlete back to competition. It is also common for cognitive behavior to normalize before reaction time and balance. Additionally, if the athlete complains of dizziness at the time of concussion, experiences loss of consciousness greater than 30-seconds, or is hit in a way that produces rotational forces to the head, they have a greater chance of an extended recovery and prolonged symptoms.

According to Bill Moreau, DC, DACBSP Managing Director of the United States Olympic Committee’s Department of Sports Medicine, “The key point regarding concussion is that all concussions are significant. In the adolescent athlete the proper care of the concussed athlete is especially important because the adolescent’s brain is still developing. All segments of society have a responsibility to help decrease concussions in sport by athletes playing by the rules, healthcare providers should protect concussed athletes by not returning them to play, officials should enforce the rules of sport, and parents should support any health care provider that holds their child out of athletics because they sustained a head injury. Each and every sign, symptom and modifying factor needs to be considered when managing concussion, especially in the adolescent population.” Prevention and management of concussions is a team sport. Healthcare providers, athletes, parents, coaches, teachers, guidance counselors and school administrators are all part of that team.

The Zurich Consensus statement including the SCAT3 and Child-SCAT3 are available for free on our website at