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Facts and Myths About Concussion

Our guest expert in August  2011 was Dr. Julia Alleyne, a sport medicine physician and medical director of Sport CARE at Women’s College Hospital in Toronto.

Concussions are mild brain injuries caused by trauma, such as a blow to the head. They can vary greatly in both severity and effects. Symptoms may range from headache, confusion and memory problems, to unconsciousness and seizures, and these symptoms may not occur immediately. Recent news stories about concussion risks in contact sports for both professional and recreational players have raised questions about the causes and effects of these injuries, as well as preventive measures.

Here are Dr. Julia Alleyne’s  answers to your questions on the Facts and Myths About Concussion. 

Q:  I live in an area where bicycle helmets are mandatory for children, but not for adults. Inconvenience (they are bulky to carry when I get to my destination) and vanity (hat hair) make it tempting to go helmet-less. How dangerous is it for adults to ride without a helmet?

The reason that helmet laws are not mandatory for adults is because of the reasons that you mention! Adults fought the helmet laws because they did not want to be mandated and told what to do. The reality is that the risk of concussion is high with cycling and there is a higher chance of adults having a concussion than children because they take higher risks, disobey road rules and take many short cuts on the road. Yes, helmets are not mandated for adults but they have been proven in study after study to reduce the risk of brain injury significantly when they are worn. So in answer to your question, cycling is a dangerous sport and the risk of concussion is high. Cycling has the highest risk of concussion in all recreational sports. And don't forget to get the right helmet in the right size!

Q: I’m a soccer mom and worry about head injuries. I think the coaches are pretty good at checking for signs of injury during the game and after, but I was recently told that people with concussions might seem fine right after the injury, but only get symptoms later.  Is this true? How can I tell if my teen has a concussion?

We now know a lot more about concussion symptoms and the course of recovery. So, it is true that obvious symptoms like loss of consciousness are not always present, but there are symptoms present if someone has suffered a concussion. The first rule is to look for impact: has the player's head hit the ground, another player or an obstacle? If yes, then that player needs immediate attention and should be taken out of the game for an assessment, ideally by medical personnel or someone trained in concussion management. Immediate symptoms may be mild like feeling dazed, fatigued or having a headache. Any player with symptoms should not return to the game and should be assessed by a physician and their family should be notified. In less common cases, players’ symptoms can seem very mild at the beginning and evolve a few days later, with significant symptoms that could indicate that a bleed or hemorrhage has occurred in the brain. For this reason, any unusual symptoms within 10 days of concussion should be assessed by a doctor.

Q: I know that contact sports like hockey and football have concussion risks, but what about sports like tennis and squash, that involve a fast-moving ball?

Yes, concussions can happen with any sport. In a game like tennis or squash, it may be an awkward hit of the ball to the head, racquet to the head or a fall with the head hitting the ground or the net post. Even two players colliding can cause an impact to the head, causing concussion. If we think of concussion happening in any of these circumstances, we begin to see that concussion is commonly sport-related but certainly not limited to high-risk sports.

Q: How hard do you have to hit your head to get a concussion?

Concussion can occur with any type of head impact or injury. It is not necessarily how hard the object or hit is, but also the place on the skull that is impacted, the ability of the athlete to prepare or be taken off guard by a hit, and the concurrent health risk factors that the individual holds (like previous concussion) that determine the severity of the injury.

Q: What are the signs or symptoms of a concussion? I’ve had memory loss and headaches for more than three weeks. Could that be a sign of a concussion?

The first sign of a concussion is that impact to the head must have occurred.

Signs and symptoms of a concussion may include:

  • headache or a feeling of pressure in the head
  • temporary loss of consciousness
  • confusion or feeling as if in a fog
  • amnesia surrounding the traumatic event
  • dizziness or "seeing stars"
  • ringing in the ears
  • nausea or vomiting
  • slurred speech
  • fatigue

Some symptoms of concussions may be immediate or delayed in onset by hours or days after injury:

  • concentration and memory complaints
  • irritability and other personality changes
  • sensitivity to light and noise
  • sleep disturbances
  • psychological adjustment problems and depression
  • disorders of taste and smell


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