# Recognizing a concussion.



## Lisa

As martial artists and as coaches of others it is important to recognize the signs of a concussion, management of the Athlete with the concussion.

I figured I would post a quick guide to recognizing and evaluating a concussion.  I know of many coaches in all kinds of disciplines that have these simple signs/symptoms and managements on small cards that they carry with them to competitions for quick reference if they are ever needed.  Good idea, IMO.

REMEMBER:  This is just a guide, if you are ever concerned with an athlete, sit them out of what they are doing and seek medical attention.

A concussion is a result of an injury/trauma that causes a temporary change in mental state.  The may be caused by a blow to the head, face or jaw or from a whiplash effect to the neck.

Signs and symptoms to recognize a concussion are:

Headache
Dizziness/dazed feeling
confused/disoriented
distracted
seeing starts/feelig "dinged" or stunned
Double or blurry vision
Sensitivity to light
Ringing in ears slepiness/loss of consciousness
Nausea/vomiting
poor balance
slow to follow instructions/respond to quesitons
unusual/inappopriate emotions/personality changes

When an athlete shows signs of a concussion they are not to return to play, not to be left alone and should be medically evaluated as soon as possible.  They will require regular monitoring for deterioration and should be awaken every 2 ours overnight for the first 24 hours.


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## Henderson

Thanks, Lisa.  Good stuff.


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## stickarts

Thanks Lisa!


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## bluemtn

Sometimes with head injuries, the pupils are different- one might be dialated, the other constricted (as a somewhat extreme example).  That's what I learned when I had taken a first aid course a while back.


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## SFC JeffJ

Great stuff Lisa.  I do however think you are just reasearching concussions so as to be better able to give me one.

Jeff


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## Lisa

JeffJ said:
			
		

> Great stuff Lisa.  I do however think you are just reasearching concussions so as to be better able to give me one.
> 
> Jeff



I am always prepared to do my modly duties


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## Slippery_Pete

tkdgirl said:
			
		

> Sometimes with head injuries, the pupils are different- one might be dialated, the other constricted (as a somewhat extreme example).  That's what I learned when I had taken a first aid course a while back.



this condition is called: aniscoria...it can be congenital or be caused by high-grade concussions or repeated concussions...be sure when first checking the athlete, if you are a ref, to check their eyes as the difference in pupil size may be normal for them ((i have aniscoria)) or if you are the athlete, make sure to tell your coach so they know...if the ref does not know and you get hit in the head and they look at your eyes, you could be DQ'ed

also an athlete with a concussion should not be able to return to play until they are asymptomatic...or showing no signs...better safe than sorry guys

it is imperative that all athletes wear a mouth guard when head contact is expected to occur...multiple studies have shown that wearing a mouth guard *significantly* decreases the severity of a concussion..mouth guard=a must!!


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## Lisa

Slippery_Pete said:
			
		

> this condition is called: aniscoria...it can be congenital or be caused by high-grade concussions or repeated concussions...be sure when first checking the athlete, if you are a ref, to check their eyes as the difference in pupil size may be normal for them ((i have aniscoria)) or if you are the athlete, make sure to tell your coach so they know...if the ref does not know and you get hit in the head and they look at your eyes, you could be DQ'ed
> 
> also an athlete with a concussion should not be able to return to play until they are asymptomatic...or showing no signs...better safe than sorry guys
> 
> it is imperative that all athletes wear a mouth guard when head contact is expected to occur...multiple studies have shown that wearing a mouth guard *significantly* decreases the severity of a concussion..mouth guard=a must!!



Good points Pete!  We had a really good discussion going on here about the importance of mouthguards.  If you wish, go check it out and add any further comments you might have.

I couldn't agree more with the better safe then sorry thing.  Don't push yourself and follow the doctor's orders so that you can return without a relapse.


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## Shirt Ripper

Slippery_Pete said:
			
		

> this condition is called: aniscoria...it can be congenital or be caused by high-grade concussions or repeated concussions...be sure when first checking the athlete, if you are a ref, to check their eyes as the difference in pupil size may be normal for them ((i have aniscoria)) or if you are the athlete, make sure to tell your coach so they know...if the ref does not know and you get hit in the head and they look at your eyes, you could be DQ'ed
> 
> also an athlete with a concussion should not be able to return to play until they are asymptomatic...or showing no signs...better safe than sorry guys
> 
> it is imperative that all athletes wear a mouth guard when head contact is expected to occur...multiple studies have shown that wearing a mouth guard *significantly* decreases the severity of a concussion..mouth guard=a must!!


 
Nothing like a little formal education and some _personal experience_ to learn ya about stuff, eh?


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## Slippery_Pete

Yeah...there is nothing quite like it...

they say that someone can tell you not to do something a thousand times but you will never learn not to do it until you have done it for yourself and experienced the consequences...its true...but i still havent learned my lesson


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## Slippery_Pete

*"My hand is like a blur...of ki." - bignick*

nice signature by the way...


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## Slippery_Pete

Here we go...

As a former athletic training student we have guidelines set about concussions...we were required to carry cards around that had this information on it...hint...suggestion...

*Signs/Symptoms*
Uncoordinated
Sensitive to light and noise
Unconscious
Short term memory loss
Foggy/Dazed
Headache
Dizziness
Nauseaated
Vacant stare
Visual problems
Slowed processing/reactions
Confused/disoriented
Sleep changes
Personality changes

*Sideline Evaluation*
*Basic Exam*
Alert and conversant
*Orientation*
Date, place, opponent, what happened
*Concentration*
Months in reverse
Any four, random sequential numbers in reverse
*Memory*
Recall three words and three objects at zero and five minutes
Recall recent newsworthy events
Recall details of contest
*Exertional Tests*
40 yd. sprint
5 push ups
5 sit ups
5 knee bends
Single leg stance with eyes closed
Straight line heel to toe walking
Sport specific exertion
*Neurological Tests*
Strength, coordination, agility, and sensation

*Concussion Grades
**Grade One:
*No loss of consciousness
Symptoms resolve in under 15 minutes
*Grade Two:
*No loss of consciousness
Symptoms last longer than 15 minutes
Requires physicians evaluation
*Grade Three:
*Loss of consciousness
Prolonged signs/symptoms
Requires immediate referral for medical care

*Return to Play Guidelines*
*Same day return:
*All signs/symptoms clear in under 15 minutes
Exertional tests do not cause return of signs/symptoms
*Return after grade two:
*Determined by physician
Must be symptom free at rest and exertion
*Return after grade three or history of repeated concussions:
*Determined by physician
Must be symptom free at rest and exertion


I would like to say that concussions should not be taken lightly and they can cause some serious long-lasting effects if not treated correctly or if the athlete returns to play too soon...another injury while the athlete is symptomatic could result in tragedy...DONT TAKE THE CHANCE

...oh and if bignick reads this...dont pay attention to the repeated concussions RTP...:lookie:


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## rabbit

I know this is not sports related but I had a concussion by being hit by a beer bottle over the head. I went staggering into the bushes and managed to make it home then I went to the bath tub and took a cold bath (dont know why) and was moaning. After that I went and drank a beer and smoked cigarettes. That night I went to sleep normally. Is this bad? The reason for my post is to know if part of my recent mental illness is caused by a hard hit to the head and no medical treatment. Also would have this kind of injury in the past make me open to death by another head trauma? I would like to do boxing ot muay thai but I think my past head truama might make it more likely for me to die by another concussion. Is this true? Thank you


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## Carol

rabbit said:
			
		

> I know this is not sports related but I had a concussion by being hit by a beer bottle over the head. I went staggering into the bushes and managed to make it home then I went to the bath tub and took a cold bath (dont know why) and was moaning. After that I went and drank a beer and smoked cigarettes. That night I went to sleep normally. Is this bad? The reason for my post is to know if part of my recent mental illness is caused by a hard hit to the head and no medical treatment. Also would have this kind of injury in the past make me open to death by another head trauma? I would like to do boxing ot muay thai but I think my past head truama might make it more likely for me to die by another concussion. Is this true? Thank you


 
Those are very serious questions.  They are worthy of asking...but they should be asked of a doctor.

I have also experienced a very bad concussion.  A head injury is nothing to mess around with.  See a doctor to be sure.

Good luck to you!


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## Lisa

rabbit said:
			
		

> I know this is not sports related but I had a concussion by being hit by a beer bottle over the head. I went staggering into the bushes and managed to make it home then I went to the bath tub and took a cold bath (dont know why) and was moaning. After that I went and drank a beer and smoked cigarettes. That night I went to sleep normally. Is this bad? The reason for my post is to know if part of my recent mental illness is caused by a hard hit to the head and no medical treatment. Also would have this kind of injury in the past make me open to death by another head trauma? I would like to do boxing ot muay thai but I think my past head truama might make it more likely for me to die by another concussion. Is this true? Thank you



Umm...I gotta agree with Carol here.  You should have seen a doctor.  Head injuries are nothing to fool around with and continuing to drink afterwards is playing with fire.  

How long ago did this happen?


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## KenpoSterre

god I wish I had read this two days ago. got hit in the head very hard by a punch during sparring by a higher rank and got a headache that lasted for 26 horus though I didn't lose consciouness. I am better now but if I had known this I wouldn't have tried to continue sparring with the bad headache. God I feel stupid now.

*moans and dies of stupidity*


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## Kacey

KenpoSterre said:
			
		

> god I wish I had read this two days ago. got hit in the head very hard by a punch during sparring by a higher rank and got a headache that lasted for 26 horus though I didn't lose consciouness. I am better now but if I had known this I wouldn't have tried to continue sparring with the bad headache. God I feel stupid now.
> 
> *moans and dies of stupidity*


You're 12 - no one expects you to know everything.  However, have you discussed this with a parent?  Concussions can have long-lasting effects if not treated, and you should be seen by a doctor.  This reinforces the need to talk to your instructor - that other student could cause serious injury if not stopped - causing a concussion goes way beyond "excessive contact" and he needs to be stopped before he does something worse.  And _please_ tell a parent - even if the headache is gone.  Residual swelling can cause problems in the future unless properly treated (if needed) - and it may not be needed - but why take chances with your *brain*?


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## KenpoSterre

my parents know. they were the ones that gave me mediacation to relieve it so I could sleep.


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## Kacey

KenpoSterre said:
			
		

> my parents know. they were the ones that gave me mediacation to relieve it so I could sleep.



That's good - just wanted to check!


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## rabbit

3 years ago


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## Lisa

Interesting article about relying on athlete response to diagnosing a concussion:



> "Overreliance on athlete symptoms has recently been criticized based on the tendency of some athletes to underreport symptoms, presumably in an attempt to speed their return to the playing field," the authors write. "We present data in this study that suggest reliance on symptoms alone is inadequate and is likely to lead to missed diagnosis of the injury in a significant number of athletes."



FULL ARTICLE


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## zDom

rabbit said:


> Also would have this kind of injury in the past make me open to death by another head trauma? I would like to do boxing ot muay thai but I think my past head truama might make it more likely for me to die by another concussion. Is this true? Thank you



Doctors are *always* going to recommend avoiding head trauma.

One thing to consider, however (someone with more knowledge please correct me if I'm wrong as I am not a medical professional, although I have grown up around the profession -- dad is a doc)

is that concussions are in part caused by the brain moving around and smacking against the inside of your skull.

Non-injurious head contact can (so I've heard) "firm up" the brain so it doesn't slosh around so much.

From what I understand, this is why some people seem impossible to knock out (although they are still susceptible to concussions).


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## Lisa

zDom said:


> Doctors are *always* going to recommend avoiding head trauma.
> 
> One thing to consider, however (someone with more knowledge please correct me if I'm wrong as I am not a medical professional, although I have grown up around the profession -- dad is a doc)
> 
> is that concussions are in part caused by the brain moving around and smacking against the inside of your skull.
> 
> Non-injurious head contact can (so I've heard) "firm up" the brain so it doesn't slosh around so much.
> 
> From what I understand, this is why some people seem impossible to knock out (although they are still susceptible to concussions).



zDom, I honestly have never heard of "firming up" your brain.  How does one do that?


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## zDom

Lisa said:


> zDom, I honestly have never heard of "firming up" your brain.  How does one do that?



Without non-injurious head contact?

Breakfalling, I would think, may do so as it also tends to firm up the other jiggly innards.


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## zDom

"A concussion occurs when the head hits or is hit by an object, *or when the brain is jarred against the skull,* with sufficient force to cause temporary loss of function in the higher centers of the brain."

(bold added by me) from http://neurology.health-cares.net

=-=-=

"The brain is made of soft tissue and is cushioned by spinal fluid. It is encased in the hard, protective skull. When a person gets a head injury, *the brain can slosh around inside the skull and even bang against it. *This can lead to bruising of the brain, tearing of blood vessels, and injury to the nerves."

(bold again added by me) from http://www.kidshealth.org/teen/safety/first_aid/concussions.html

=-=-=

I found this page: http://tkdtutor.com/11Training/Knockouts.htm

which gives advice on how to prevent being knocked out, but wasn't able to confirm the idea of "firming up" your brain anywhere (have to get back to work...)

I'll try to get back to you on that. I'm pretty sure I got it from a reliable source, but it's been awhile.


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## zDom

Lisa, I am going to have to ask that you ignore my claim of being able to "firm up" the brain.

While it could possibly be true, the source where I heard it from could have been wrong -- especially since I am presently unable to find anything which confirms this theory.

It is better to err on the side of caution, after all.

Everything I've read over the last couple of hours indicates you may be able to increase your resistance to knockouts/concussions by strengthening the neck and jaw muscles.

I see no health hazards or drawbacks in that approach, so for the time being that is the only approach I will recommend.

It is important, in my opinion, to be able to defend yourself even after receiving a hard blow to the head that puts you in that dreamy state that must be one of the less-severe levels of concussion.

I've personally done the above by engaging in heavy to full contact sparring with my former TKD instructor. I've never, on the other hand, subjected any of my students to that kind of sparring or recommended that take part in it as, again, it is better to err on the side of caution.

Growing up, I've been hit in the head a lot but never hard enough to knock me out (hard enough to leave one permanent dent in my skull, however....)

I guess it's kind of like saying, "I made it over to this side of the chasm by walking across that extremely dangerous bridge that might break and dump you into the chasm. I advise you find another way here as that bridge is definately not safe."

I have no idea at all what a safe route here might be, however.

Anybody out there have any ideas? Is conditioning against head trauma possible?


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## NDNgirl4ever

I'd also like to add that you should never let a person with a suspected head injury go to sleep for at least 3-4 hours afterward. If they report being sleepy, or seem drowsy, call 911 or get them to the ER. They could be slipping into a coma.


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## Ninjamom

From Aetna Inteli-health Website (information reviewed by faculty at Harvard Medical School):



> Headache and neck pains can be treated with over-the-counter pain relievers. Most doctors *recommend acetaminophen (Tylenol and other brand names) instead of anti-inflammatories such as ibuprofen (Advil, Motrin and other brand names) or naproxen (Aleve) because acetaminophen is less likely to cause bleeding*. If you have more severe pain, your doctor may give you a prescription pain reliever.


 (Bold added by me) Something to remember if an athlete is injurred in a sparring match or practice and complains about headache.

The complete web article on concussions, including symptons, when to call 911, treatment, and prevention, may be found here: 
http://www.intelihealth.com/IH/ihtIH/WSIHW000/9339/9740.html


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## tellner

zDom, back in the day someone else made a similar suggestion. I talked to a couple people with actual professional experience in treating concussions - two physicians, a former Green Beret who was a "super medic" and combat surgeon and  to a paramedic. They thought your idea of "firming up the brain" and the idea that having strong neck and jaw muscles could prevent concussions was (and I quote) "Incredibly dangerous", "suicidal", "insane", "Where do martial artists make up this bull****?" and a few things less printable. 

What happens when you "toughen up" your brain by getting hit is that you lose brain cells. They don't grow back except for pregnant women. If you want to do serious drinking later on you will need those extra brain cells


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## qi-tah

zDom said:


> Anybody out there have any ideas? Is conditioning against head trauma possible?


 
How about wearing a motorcycle helmet when you spar?? ;-) Seriously tho - short answer is no. Scar tissue or dead areas on the brain are not to be recommended. And there is no known way to "firm up" cerebro-spinal fluid, which is what the brain is surrounded by, nor would you want to, it's there for good reason. 

I used to play rugby union before i got into martial arts and was knocked out playing a state match... apparently after i was taken from the field i came to and was begging the coach to let me back on - i have no memory of this now. Thank the stars he knew enough to keep me still and under observation until i could be taken to hospital.


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## Indie12

Lisa said:


> As martial artists and as coaches of others it is important to recognize the signs of a concussion, management of the Athlete with the concussion.
> 
> I figured I would post a quick guide to recognizing and evaluating a concussion. I know of many coaches in all kinds of disciplines that have these simple signs/symptoms and managements on small cards that they carry with them to competitions for quick reference if they are ever needed. Good idea, IMO.
> 
> REMEMBER: This is just a guide, if you are ever concerned with an athlete, sit them out of what they are doing and seek medical attention.
> 
> A concussion is a result of an injury/trauma that causes a temporary change in mental state. The may be caused by a blow to the head, face or jaw or from a whiplash effect to the neck.
> 
> Signs and symptoms to recognize a concussion are:
> 
> Headache
> Dizziness/dazed feeling
> confused/disoriented
> distracted
> seeing starts/feelig "dinged" or stunned
> Double or blurry vision
> Sensitivity to light
> Ringing in ears slepiness/loss of consciousness
> Nausea/vomiting
> poor balance
> slow to follow instructions/respond to quesitons
> unusual/inappopriate emotions/personality changes
> 
> When an athlete shows signs of a concussion they are not to return to play, not to be left alone and should be medically evaluated as soon as possible. They will require regular monitoring for deterioration and should be awaken every 2 ours overnight for the first 24 hours.


 
Good Points!! I'd also add that in many areas, while you may 'suspect' a concussion, and take appropriate steps to assist the person, unless your a qualified medical physician (some areas may include nurses, ANRP, PA, or Medic) you cannot treat and release a suspected concussion person. You have to seek medical treatment on the spot and/or call for EMS.


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## shima

I just got my first concussion this past Saturday (during my grand champion sparring match). Had a wicked headache afterwords, meds didn't help too much... went to bed around midnight that evening, woke up around 5am and threw up... called my mom who's a doctor and she told me to go to the ER and get a CT scan. Luckily CT scan did not show any serious damage, but the ER doc agreed that I had a concussion and needed to take it easy for a week and to get rechecked next week before I start sparring again. 

How long should one wait before doing "serious" (aka tournament) sparring after a concussion? I have another tournament next month that I was looking forward to rematching this girl I fought on Saturday...but I'm not sure if one month is too short of a time before risking re-injury. My brain is something I definitely don't want to permanently damage!


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## Dirty Dog

That's a tricky question. Did they happen to mention what grade of concussion you had?

In GENERAL, it's ok to return to contact sports when you have been symptom free for a minimum of one week.
The key there is SYMPTOM FREE. Not mild symptoms. No symptoms.


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## jks9199

shima said:


> How long should one wait before doing "serious" (aka tournament) sparring after a concussion? I have another tournament next month that I was looking forward to rematching this girl I fought on Saturday...but I'm not sure if one month is too short of a time before risking re-injury. My brain is something I definitely don't want to permanently damage!



Get guidance from your doctors.  You may want to consult a sports medicine doc or a neurologist.  We've really learned how important it is to properly treat concussions and to really be sure that you've recovered before you risk further injuries over the last several years.  You might use this as an opportunity to help introduce concussion management programs to your school.


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## Cyriacus

Im no doctor, but i do know that even risking aggravating a concussion is not good. Dont do it. Let it heal, completely.
Even if you cant rematch her, dont sweat it. Theres always next time. Then you can be even more prepared, and dish out more of a comeback. Patience!


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## kelly45

very good information ... everyone should know this and keep it in mind


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## dvcochran

rabbit said:


> I know this is not sports related but I had a concussion by being hit by a beer bottle over the head. I went staggering into the bushes and managed to make it home then I went to the bath tub and took a cold bath (dont know why) and was moaning. After that I went and drank a beer and smoked cigarettes. That night I went to sleep normally. Is this bad? The reason for my post is to know if part of my recent mental illness is caused by a hard hit to the head and no medical treatment. Also would have this kind of injury in the past make me open to death by another head trauma? I would like to do boxing ot muay thai but I think my past head truama might make it more likely for me to die by another concussion. Is this true? Thank you



I have had 5 known concussions, and had a metal shunt in my noggin for a while. Three from sports (two college football), two from auto accidents (not my fault). My advise, live life without fear, it only comes around once. My advice, don't be stupid with risk.


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