Concussions 101: You don’t ‘shake off’ a blow to the head

By Kristine Thomas

Silverton High School seniors Olivia Dahl and Katie Spink describe having a concussion like being grounded for something they didn’t do and they can’t get out of it – until they passed the test.

“We weren’t allowed to do any stimulating activities like texting, driving, watching movies or TV, listening to music or being on the computer,” Dahl said. “We just had to stay home and sleep.”

“I could only have friends over for a little bit and I would ask them if they wanted to color,” Spink said. “I had the worst Christmas break because I couldn’t go anywhere or do anything but stay in my room.”

Spink and Dahl got concussions while playing basketball – Spink on Dec. 15 and Dahl on Jan. 27. Spink received the doctor’s OK for limited time playing basketball in July; Dahl can’t play until the season starts in November. Both said the consequences or having a concussion were tough.

The greatest challenge for the girls was the negative comments they received from peers who didn’t understand the extent of their brain injury and the impact having a concussion had on their academics and life.

Dahl and Spink said their peers told them to  say they felt OK so they could play. They tried that and failed because SHS athletic train Jennifer Krug knew they weren’t being honest and they each failed the test that measures cognitive ability several times.

“I didn’t want to have a concussion,” Spink said. “I would rather have gone to basketball practice for six hours a day and be normal again than have a concussion.”

Having a concussion made them feel anything but normal with both suffering from headaches, mood swings, tiredness, sensitivity to light and noise and memory problems. What they did have was one another’s support and friendship.

“We would send each other texts asking if it was a good day or a bad day,” Dahl said.

According to the Oregon School Activities Association, an estimated 800 high school athletes suffer concussions each year.  The passage of Max’s Law, implemented in the 2010-11 school year, requires Oregon schools to follow specific procedures for returning student athletes who suffered a concussion before they return to play and academics.

Max’s Law is named after Max Conradt, a former Waldport High School quarterback who suffered a permanent brain injury in 2001 while playing in a football game – despite feeling the effects of what might have been a concussion suffered in a game a week earlier.

The law requires training for coaches and athletic trainers so they can recognize the signs of a concussion. Before the start of a season, every athlete must take a baseline test. If an athlete is suspected of having a concussion, they must pass a corresponding test. The athlete also needs to get permission from his or her doctor working with the school’s athletic trainer before returning to competition.

What is a concussion?

Dr. Dan Schweigert, of the orthopedics and sports medicine program at Silverton Health, works with the athletic trainers at Silverton, Kennedy and Woodburn High schools as well as Willamette University.

“A concussion is a mild, traumatic brain injury,” Schweigert said. “Most people get a concussion when they get a blow to their head. They can also get one when they get whiplash, hit in the neck or the brain gets jostled.”

In sports like football or ice hockey, Schweigert said athletes are prepared for contact, unlike basketball or soccer where a hit is more unexpected.

When an athlete breaks his finger, a doctor can see the break by taking an X-ray. A concussion affects how the brain works. It’s a problem of function, not structure. A concussion is not an injury that can be seen.

“A MRI, CAT scan or X-ray cannot tell a doctor if a patient has a concussion,” he said. “A concussion is a metabolic injury to the brain where the metabolism of the brain is thrown off.”

Probably the easiest way for adults to understand a concussion, Schweigert said, is the symptoms are “very similar to having an hangover.”

Headaches, confusion, sensitivity to light and noise, difficulty concentrating, nausea, memory loss, dizziness, feeling like the room is spinning and wanting to sleep are all signs of a concussion, Schweigert said.

He stressed the fact that no two concussions are the same. Each depends on the athlete, age, the number of concussions and where the hit in the head occurred, as each part of the brain controls different functions, he said.

If an athlete displays any signs of a concussion, the most important advice Schweigert gives is to take it slow to return to the playing field.

“There is no rush to return to playing,” he said. “The goal is to prevent further injury to the brain or brain damage.”

Schweigert said he tells his patients he doesn’t know how long it will take to heal.

“My goal is for the athlete to properly heal and to prevent a more serious injury from happening,” he said. “Sometimes an athlete may need to have rehabilitation depending on where he was hit. A concussion can affect speech, memory and balance.”

Realizing athletes are eager to return to play, he has had some who told him they were feeling fine when they weren’t. He cautions athletes to be honest with his or her athletic trainer and doctor about the symptoms.

“What the brain really needs after a concussion is rest,” he said. “I try to keep my patients out of school and use a graded approach to recover with the first step going back to school, then slowly work to getting back to competition.”

Silverton High Athletic Director and Assistant Principal Greg Kaatz said the passage of Max’s Law has heightened the sense of urgency with respect to observable symptoms of a concussion.

Realizing players, coaches, administrators and parents are not medically qualified to diagnose a concussion, Kaatz said the mandated trainings required by Max’s Law is the “next best thing which is to observe signs that a concussion may have occurred.”

An equally important piece to the law is the return to play protocol which outlines athletes can return to play once they can perform progressive athletic movements over a period of time without concussion symptoms, Kaatz said, adding the time period varies athlete to athlete.

Kaatz also explained all athletes are required to participate in the Impact Concussion Management System. Before the season, each athlete takes a baseline test. If diagnosed or suspected of having a concussion, the Impact Test is administered.

“This is a computerized system that acts as a tool to aid in the return to play procedure at our school,” Kaatz said. “We have also participated in a concussion education study, which targeted athletes and parents.”

Kennedy High School athletic trainer Jeff Crapper said the Impact Test is a cognitive exam testing reaction time, problem solving and short and long term memory.

Although there is no way to prevent an athlete from getting a concussion, Kaatz and Crapper said coaches at their schools emphasize weight lifting and conditioning as ways to minimize concussions.

“Providing an opportunity and making it a priority to physically strengthen the body is the only variable we can control,” Kaatz said.

Kaatz stressed the importance of everyone being aware of the signs of a concussion.  “If a concussion is diagnosed, it means the brain needs to rest to heal,” he said. “Providing an environment to do that is about the only thing a person can do to help.”

Crapper emphasized the importance of educating parents, teachers, coaches and administrators about the seriousness of the injury. Too often, people believe a concussion is only bad if a person is knocked unconscious.

Before coming to Kennedy he had parents insist their son play with a concussion. “They were worried about losing a scholarship,” he said. “The goal of all of this is to keep students safe. We can’t underestimate how severe concussions are.”

Crapper invited Max Conradt to visit Kennedy High in May 2011.

“He was a kid with a 3.9 GPA and he had a promising future with college ahead of him. He thought he was invincible,” Crapper said. “He now has a permanent disability. It was touching to see first hand what playing with a concussion can do to a person.”

Both Spink and Dahl are grateful of the support they received from their coaches, teachers, athletic trainer and administrators. Looking back, they realize how serious their injuries were and how important it was to listen to their doctor and athletic trainer.

Both girls were referred to the Slocum Center for Orthopedics and Sports Medicine in Eugene, where they saw Dr. Michael Koester. Both know if they get a concussion again, they are done with contact sports. Neither athlete wants to be “grounded” again, especially now they are back to “normal.”