KNOCKOUTS
& CONCUSSIONS
February
2007
ABSTRACT
What
is a concussion?
What
causes a concussion?
 |
 |
Symptoms
of a concussion
2) Amnesia
3) Nausea and/or vomiting
4) Poor attention and concentration
5) Confusion & disorientation
6) Blurred/double vision
7) Slurred speech
8) Loss of coordination & unsteady on the feet
9) Dizziness
10) Headache
Grading
concussions
“Concussions”
By Jonathan Cluett, M.D.
By Jonathan Cluett, M.D.
Grade 2 - A moderate concussion, with confusion and difficulty recalling the event, but no loss of consciousness.
Grade 3 - A severe concussion, where there is a loss of consciousness and no memory of the event.
When can an athlete return to play following a concussion?
Although guidelines are useful, every case must be considered individually. The following guidelines are only a reference to consider--each patient who sustains a concussion must be evaluated by their physician before being cleared to return to activity!
In general, athletes will be allowed to return to play according to the following schedule:
• For Grade I Concussions:
The athlete can return if they are asymptomatic for at least 15 minutes.
• For Grade II Concussions:
The athlete can return to play after one week, if asymptomatic during that time period.
• For Grade III Concussions:
The athlete is removed from competition and transported to the emergency department. Length of time out of competition can be discussed with the physician.
All patients who sustain a concussion must not return to play until cleared by someone trained in management of these injuries (e.g. the team physician). Foremost, any athlete should not return to play until ALL symptoms have resolved. Even a mild headache should exclude a player from returning to competition.
Athletes who sustain multiple concussions must not return to play until properly evaluated. In general, athletes who sustain three concussions, no matter what grade, will be removed from competition for at least one season. The dangers of multiple concussions are not well understood, but athletes, coaches, and team doctors must be willing to play it safe.
(Extract from www.orthopedics.about.com)
The
American Academy of Neurology's guide to management of concussion in sports:
Transient confusion
No loss of consciousness
Concussion symptoms or mental status abnormalities on examination resolve in less than 15 minutes
Grade 2
Transient confusion
No loss of consciousness
Concussion symptoms or mental status abnormalities on examination last more than 15 minutes
Grade 3
Any loss of consciousness
Management
recommendations
Grade 1
1. Remove from contest
2. Examine immediately and at five-minute intervals for the development
of mental status abnormalities or post-concussive symptoms at rest and
with exertion
3. May return to contest if mental status abnormalities or post-concussive
symptoms clear within 15 minutes
Grade 2
1. Remove from contest and disallow return that day
2. Examine on-site frequently for signs of evolving intercranial pathology
3. A trained person should re-examine the athlete on the following day
4. A physician should perform a neurological examination to clear the
athlete for return to play after one full asymptomatic week at rest and
with exertion
Grade 3
1. Transport the athlete to the nearest emergency department by ambulance
if still unconscious or if worrisome signs are detected (with cervical
spine immobilization, if indicated)
2. A thorough neurologic evaluation should be performed when consciousness
is regained, including the appropriate neuroimaging procedures when indicated
3. Hospital admission is indicated if any signs of pathology are detected,
or if the mental status of the athlete remains abnormal.
When to return to play
Grade
of concussion |
An
athlete may return to play only after being asymptomatic with normal
neurologic assessment at rest and with exercise |
| Grade 1 Concussion | Return in 15 minutes or less |
| Multiple Grade 1 Concussions | Return in one week |
| Grade 2 Concussion | Return in one week |
| Multiple Grade 2 Concussions | Return in two weeks |
| Grade 3 - Brief Loss of Consciousness (seconds) | Return in one week |
| Grade 3 - Prolonged Loss of Consciousness (minutes) | Return in two weeks |
| Multiple Grade 3 Concussions | Return in one month or longer, based on decision of evaluating physician |
Discussion
Over the years I’ve watched many boxing and kickboxing fights where the same fighter has received 4-5 standing 8 counts over the duration of a fight. If we look at the recommendations for grading concussions, a fighter that receives a standing eight count (which equates to a grade-1/grade-2 concussion), should be rested and assessed over the next 15 minutes (not 8-seconds), if after 15-minutes there are no signs and symptoms of a concussion present, the fight should then be allowed to continue, if after 15-minutes there are still signs and symptoms of a concussion present, the fight should then be stopped. If we look at the guidelines for grading concussions, standing 8 counts and more importantly repeated standing counts should never happen.
The question now is “Is the system used for grading concussions flawed?” or “Are the majority of combatants that participate in sparing and full contact fighting suffering from permanent brain injuries?”
The studies on head injuries where the guidelines for grading concussions are derived from, are largely base on motor vehicle accidents, therefore allot of the concussions that appear in the studies are serious and often life threatening grade-3 concussions that are caused by force far greater than any force encounted in the ring/cage.
This doesn’t mean that we can get complacent about concussions/repeated concussions that are sustained through combat sports. Every concussion is individually different and every concussion is potentially serious and life threatening, on average there are 10 deaths a year from boxing.
The guidelines derived for an athlete returning to sport after a concussion or a series of concussions are generally based on the approximate time it would take the brain to heel after being bruised/injured. This heeling time for the brain helps to alleviate a serious but rare condition called “second impact syndrome”, which is where an initial concussion is followed up with a second concussion (affecting the same part of the brain) before the brain has heeled from the original concussion. The consequences of the “second impact syndrome” happening are quite serious and can often result in death.
To come up with a specific grading system for concussions for combat sports that takes into consideration
1) Participants who enjoy sparing, which often results in intermittent grade-1 and grade-2 concussions.
2) Participants who spar and fight full contact, which often results in intermittent to regular grade-1 and grade-2 concussions and the occasional grade-3 concussion
would require a specific long term study conducted by medical staff that specialise in head injuries. The likelihood of such a study ever being undertaken borderlines on the impossible as the majority of medical staff that specialise in head injuries, see serious head injuries on a regular basis and therefore don’t condone combatant sports where participants intentionally attempt to inflict head injuries on each other.
ApoE4
1) Is a strong indicator to the onset Alzheimer’s in later life.
2) Appears to increase the extent of injuries to the brain, following concussions.
Memory
loss after brain injury worse when E4 form of Alzheimer's gene present
This is the first study in humans to show that recovering memory after brain injury is harder for people who have the E4 type of the apolipoprotein E (APOE) gene which is already known to influence Alzheimer’s disease.
"Although APOE has been implicated in traumatic brain injury recovery before, this is the first time that it has been associated with a specific deficit," said lead author Fiona Crawford PhD, of the Roskamp Institute at USF.
"The findings have implications for understanding repair and recovery after traumatic brain injury, as well as the neurodegenerative mechanisms, and suggest common cellular responses in head injury and Alzheimer’s disease."
The study looked at 110 head-injured patients who were rated for level of traumatic brain injury, assessed for memory function and genotyped at the APOE gene.
Although participants with the E4 form of the APOE gene matched those without the E4 form in terms of age, gender and severity of injury, there were clear differences in memory function between the two groups. The E4 group showed worse recovery of general memory function after injury. Ongoing work at the Roskamp Institute is pursuing the findings.
(Extract from www.neuroskills.com)
Discussion
If there is a family history of Alzheimer’s and you are involved in combat sports or interested in taking up combat sports that involve striking to the head, then you should at least be aware of the possible ramifications of possessing this gene. If there is a family history of Alzheimer’s and you compete in full contact fighting or are interested in competing in full contact fighting then you should consider getting tested to see if you have the ApoE4 gene.
Although there still needs to be more research undertaken, current research shows that if you have the ApoE4 gene you are more than likely going to get Alzheimer’s in later life and any concussions you receive during your lifetime are more than likely going to be more serious than if you didn’t have the ApoE4 gene.
Head
gear & boxing Gloves
Head gear like thicker boxing gloves does little to stop the head from moving violently after being struck which is the main cause of concussions in combat sports, however head gear does assist in avoiding cuts.
How
dangerous are combatant sports?
(www.thesweetscience.com)
Sports |
Deaths
Per Year |
| Boxing | 10 deaths per year |
| College football | 11 deaths per year |
| Horse racing | 23 deaths per year |
| Motor cycle racing | 77 deaths per year |
| Hang gliding | 169 deaths per year |
| Mountaineering | 308 deaths per year |
| Sky diving | 370 deaths per year |
| Scuba diving | 1100 deaths per year |
Out of all combatant sports, I would rate boxing the most dangerous as the sole objective of boxing is to throw punches at your opponents head (and occasionally the body) in an attempt to knock out your opponent. When a fighter is stunned or knocked down (which equates to a grade-1 or a grade-2 concussion), they are given a standing eight count (eight seconds) to get to their feet and convince the referee that they are capable of continuing only to face an impending onslaught as their opponent further attempts to end the fight by inflicting another concussion on the already injured fighter. This often results in several grade-1/grade-2 concussions, with the possibility of an additional grade-3 concussion to end the fight.
I would rate kickboxing/muay thai the second most dangerous combatant sport, here the intentions of the fighters are to attack the body in addition to attacking the head, therefore over the duration of an average fight, the volume of strikes that specifically target the head is going to be less than the volume punches that target the head in a boxing fight. Kickboxing/muay thai also employ a standing eight count as a part of their rules, which like boxing, can result in several grade-1/grade-2 concussions, with the possibility of an additional grade-3 concussion to end the fight.
I would rate MMA the least dangerous combatant sport as repeated grade-1/grade-2 concussions are rarely seen. In MMA rules, the injured fighter isn’t given a standing eight count in an attempt to regain their facilities, only to defend the impending onslaught in an altered state of mind, once a fighter is stunned or knocked down (which equates to a grade-1 or a grade-2 concussion) and can no longer adequately defend themselves, the fight ends there.
Key
points
2) When competing in the ring/cage, a doctor is always on hand so each fighter can be checked out immediately after a fight, however when sparing, more often than not doctors aren’t present, therefore
a) Any grade-1 concussion sustained while sparing should be followed up with a visit to the doctors.
b) Any grade-2 concussion sustained while sparing needs to be followed up with a visit to the doctors.
c) Any grade-3 concussion sustained while sparing needs to be followed up with a visit to the hospital (in an ambulance if necessary).
3) All sparing sessions at gyms, training centers etc should only be conducted if there is a person qualified in “first aid” present.
4) All gyms, training centers etc should have a “first aid” plan in place should an emergency arise.
5) The decision of when to return to sport after a concussion or a series of concussions is for the doctor/specialist to make, not the injured party or the coach/instructor.
6) Only use minimal impact to the head while sparing, especially if you have no intentions of fighting full contact.
7) If there is a family history of Alzheimer’s you should to be aware of the possible consequences of possessing the ApoE4 gene.
Conclusion
100Kb
