Treating sports-related head injuries

In this video, we review sports-related syndromes and discuss when it's safe for a high school athlete to return to play after a neck injury and when returning to play could make things worse.

Gary R. Simonds, MD MHCDS FAANS
Gary R. Simonds, MD MHCDS FAANS
14th Nov 2020 • 3m read

Some sports-related syndromes may be similar to spinal cord injury syndromes, but are less concerning. In this video, we review these syndromes and discuss when it’s safe for a high school athlete to return to play after a neck injury, and when returning to play could make things worse.

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Video transcript

There are a wide array of injuries to the head and spine that can be sustained in kids sports. There's a tendency to demonize certain sports such as American football and rugby, due to relatively high rates of concussion, and spinal injuries. It bares noting, however that many other less supervised youth activities such as biking, skateboarding and horseplay are also associated with high rates of serious injury.

In this Medmastery lesson, we'll briefly review the assessment and management of an acutely head injured athlete at a sporting event or on a practice field. If an athlete is unconscious assess their airway and breathing, but do not try to reposition or remove helmets, or protective pads, and please do not use smelling salts, or try to aggressively wake up the athlete.

Check and note the player's response to pain, and check pupils for size and reactivity. Summon emergency medical services and assist with positioning the athlete on a spine board for swift evacuation to a medical center. If an athlete was knocked unconscious, but is now awake, remove them from competition or practice.

They have sustained at the very least, a substantial concussion. Assess them for neck pain, and for neurological complaints. Assess cognition, balance, coordination and motor function. If the athlete is experiencing neck pain, or neurological complaints, paralysis or weakness, or if the athlete is not fully alert and oriented, initiate spinal precautions and call for emergency medical services to transfer to a medical center.

In a patient with any of these symptoms, assess their airway and breathing, and perform a cursory neurological exam, but do not attempt to move them. In a patient who is knocked unconscious, and is now awake and alert, and has no major complaints, and no major findings, they still require formal medical evaluation.

Remember, serious cranial hemorrhages, such as epidural hematomas can be associated with a period of lucidity after the initial loss of consciousness, and prior to profound deterioration. If an athlete experienced a head trauma, but was not knocked unconscious, and seems well, assess for persistent symptoms, or neurological signs.

If the patient has any signs or symptoms of neurological dysfunction or distress, such as headaches, dizziness, or nausea, they have at least a concussion, and should not return to play. Persistent signs and symptoms should be evaluated at a medical facility. To return to play at a sporting event, or a practice after a head trauma, or downstream after recovery from a concussion, an athlete must be able to participate in vigorous exercise, without any neurological signs or symptoms whatsoever. An athlete who has sustained a concussion, should be out of his or her sport for at least one to two weeks.