Concussion Q&A: What to know as fall sports kick off

As fall sports get underway in South Carolina, a sports medicine specialist at MUSC Health is encouraging players, coaches and families to keep an eye out for concussions. Shelli Ciandella, M.D., said it’s important to recognize them during games and afterward to protect kids’ health. Here’s more from her in this Q&A.

Q: High school football starts on Aug. 22 in our state. Is it safe to say you’ll see more kids with concussions coming in?

A: For sure. It’s so much more common this time of year.

Q: Is there anything new, protection- or prevention-wise?

A: I think a lot of the prevention comes from coaches teaching football players how to hit and how to fall and trying to protect them. But concussions are kind of crazy because you don't even necessarily have to have direct head-to-head contact to have one. It can be anything that sort of rattles the brain.

Or they fall, and they get whiplash, and that causes the concussion symptoms. So really, it's any sort of head injury plus symptoms. 

Obviously, football players are wearing helmets, but that protects them more against a traumatic skull injury and brain bleed. You can still get a concussion with a helmet on. 

Q: How do you know if someone has had a concussion?

A: As far as the definition goes, it is truly some sort of head trauma plus symptoms. The symptoms can be common ones, like headache or difficulty concentrating, but they can also be mood changes. So sometimes, they're just a little bit more subtle. 

If they have symptoms after a head injury, they should be seen by a professional. The super bad, scary symptoms are if they lose consciousness, if they have any difficulty with speaking or their level of consciousness seems low, like they're just drowsy, then those are much more concerning. Then they need to go to the Emergency Department.

Q: There’s a lot of talk about concussions these days, with some of them caught on video – like the ones Tua Tagovailoa, the Miami Dolphins’ quarterback, has had. Basketball star Paige Bueckers recently had one, too. Has that made people more cautious?

A: Yes. I have seen much more focus on concussions recently, especially with the addition of a lot of our athletic trainers at schools. I think it was just underreported before. Now that we have athletic trainers on the sidelines of a lot of these games, they are identifying these symptoms. 

And then I think with some of the more high-profile concussion cases in the NFL as well, thankfully people are like, “Oh this is a problem. And if my kid has one of these, I need to take them to see a doctor.” So concussions are definitely reported more often now than probably 10 years ago, even. 

Q: Can you talk more about the athletic trainers on the sidelines of games?

A: All the schools affiliated with MUSC have an athletic trainer on the sidelines for at least football. And then a lot of the time, we have a doctor with the team at the high school football games as well. 

More times than not, MUSC has a doctor out there. We have EMS, and we have an athletic trainer, so there's a pretty good team there ready to identify kids that are acting differently after a head trauma and things like that because sometimes, the kids won't report the symptoms.

Q: How long does it take to recover from a concussion?

A: It can take a couple of weeks, but more times than not, it doesn't. I try and encourage the kids just to be honest, since we don’t have a perfect test that will tell us if they have a concussion, aside from them reporting symptoms.

Mostly, we talk them through it. Rest is the most important part. They cannot get back into the sport right away. They usually have to take a couple of days. 

Q: There’s not a test?

A: There are a couple of trial devices that we have tested in an effort to detect concussions. A lot of times, it requires pretesting. So if athletes are able to test in the preseason and then, obviously, after a potential concussion, we can see if things like reflexes are different. But none of them that I've seen have really panned out. They're a helpful tool, but I'm not exclusively using that to diagnose a concussion. 

I am mostly relying on symptoms and then obviously their exam. I do feel like the eye muscles are pretty sensitive. So if you have a kid who’s telling you that they feel great, you can do an eye exam, and a lot of times that can show symptoms. But sadly, there’s no universally used concussion tool at this time. 

Q: What kind of a difference does early treatment make? 

A: If they don't go through the return-to-play protocol, they might not get better as quickly as we would like, if they’d had early treatment. That protocol starts with getting back to school, which is a priority. Then light exercise, like walking, and ramping back up from there. 

We have a Concussion Clinic at MUSC through pediatrics. Many of our sports providers in the Orthopedics Department see patients for concussions and prioritize getting them in quickly. And then there's a Saturday morning injury clinic in the West Ashley Medical Pavilion for kids who got injured on Friday night. It’s from 9 to 11 and is staffed by sports medicine doctors. 

Anything concerning needs to go to the ER, like a skull fracture or a brain bleed. Usually, it's pretty obvious. And it’s always better to be safe than sorry, if there's any concern.