Pediatric Medical Center is open by appointment M–F 9-5:15 and Sat from 8:30am. Closed Sundays. 562-426-5551. View map.

The Informed Parent

Head Trauma In Sports

by Louis P. Theriot, M.D., F.A.A.P.
Published on Oct. 22, 2001

It was late in the second quarter with less than three minutes left before half time. The Braves, trailing 13-7, were moving the ball with precision. They had the ball on the opponent’s 23 yard line, capping a drive that started on their own 20. It was now fourth down and two yards to go for a first. The defense dug in as the Braves were going for the first down. The quarterback took the snap and faked a handoff to the big fullback who lumbered straight up the middle, taking with him most of the defense’s line. The QB then stepped back and, in one quick motion, fired a bullet of a pass to the tight end who streaked across the middle of the field. Just as the end caught the ball, he was struck by the free safety who was NOT fooled by the fake run. It was a cataclysmic hit that reverberated throughout the stadium. Surprisingly, the tight end held on to the ball, but laid on the grass in the fetal position, slow to move. He got up on all four, and then rolled on his back holding his helmet with his hands as if he was stargazing. As team doctor, I raced out to the player who was now sitting up and unbuckling his chinstrap.

I took out his mouth guard as he looked at me with a dazed expression…he actually seemed to be looking THROUGH me. The referee cleared the other players away to make room. After being assured that he could move all four extremities, and that his neck was not involved, I took off his helmet. “We got the first down, didn’t we?” he asked with a grin. He then rubbed his eyes, and one could almost see the tweety birds circling around his head. He stated, emphatically, that he had not been knocked unconscious. The field umpire corroborated the fact. “I saw the whole thing, and he wasn’t out,” he said without reservation.

I did a neurological exam on the spot, and he passed with flying colors. Jumping to his feet he started back to the huddle while putting his helmet back on. The referee intercepted before he got too far and told him that he had to sit out a play. I took him by the arm and escorted him to the sidelines where I did a more thorough neurological exam. He was perfectly intact. He could tell me his phone number, the date, the score of the game, and could count backward from 100 by threes. He vehemently protested when I declared that I wanted him to stay out of the game until the second half. “Doc, I just got my bell rung,” he pleaded, to no avail. “Can’t I go back into the game?” The protestations were somewhat tempered when his team scored and they took the lead 14-13.

I re-examined him as half time came to an end, and he was medically cleared to play the second half. He did play and turned in a wonderful performance. I again re-checked him after the game, and he was just fine.

This is a common problem for physicians who are involved with sports. It is estimated that each year, sports participants in the United States experience as many as 300,000 mild-to-moderate head injuries that could be classified as concussions. There are a number of guidelines that have been devised to determine exactly what to do with these athletes. There are subtle differences between these guidelines—the Colorado Medical Society Sports Medicine guideline, the American Academy of Neurology guideline, and the guidelines set up by Dr. R.C. Cantu. Yet, for the most part, they are similar. They differ primarily on when the athlete may return to play.


Colorado Medical Society's guidelines For Returning To Play
Severity 1st Concussion 2nd Concussion 3rd Concussion
Grade 1
Confusion, no amnesia. No loss of consciousness Can play if no symptoms for 20 minutes Terminate pracitice for the day Terminate season — may return in 3 months if no symptoms
Grade 2
Confusion AND amnesia. No loss of consciousness Terminate play. May return if no symptoms for at least 1 week Season in question — may return if no symptoms for 1 month Terminate season. May be able to play next year
Grade 3
Loss of consciouness May return after 1 month IF symptoms free for 2 weeks Terminate season — future participation discouraged  

These guidelines, and those established by Dr. Robert C. Cantu, are the two sets that are perhaps best known to sports-minded physicians. There are minor differences between the two. In the Colorado guidelines, an athlete who sustains ANY loss of consciousness would be classified as having a severe concussion. He would be kept from participating from that sport for a month. But, under Cantu’s guidelines, loss of consciousness for less than five minutes, or amnesia up to 30 minutes, would be classified as a grade 2, or moderate concussion. That athlete would be cleared to return to the sport in one week if symptom free. Which guideline a team doctor uses isn’t critical. What truly matters is that the physician is comfortable with the system he or she uses.

Another very serious concern that trainers, coaches and team doctors should be well aware of is the Second Impact Syndrome (SIS). This occurs when an athlete who has sustained an initial head injury, usually a concussion, sustains a second head injury before the symptoms of the first injury have fully cleared. There are countless reports of such sports injuries whereby the athlete receives a second “fairly mild head injury”. He then collapses into a coma and dies. It is critical that after sustaining ANY head trauma, the athlete is carefully evaluated and cleared to return to play, IF AND ONLY IF certain criteria are met. Failure to do so puts that athlete at risk for a SIS, which is a fatal yet preventable event.

© 1997–2017 Intermag Productions. All rights reserved.
THE INFORMED PARENT is published by Intermag Productions, 1454 Andalusian Drive, Norco, California 92860. All columns are stories by the writer for the entertainment of the reader and neither reflect the position of THE INFORMED PARENT nor have they been checked for accuracy. WARNING: THE INFORMED PARENT or its writers assume no liability for information or advice contained in advertisements, articles, departments, lists, stories, e-mail question/answers, etc. within any issue, e-mail transmissions, comment or other transmission.
Website by Copy & Design