You take off from the gates and due to some unfortunate timing the holeshot doesn’t go as planned and you crash. You feel dizzy and a little disoriented. When you get back to your trailer you are having problems remembering what happened, and you have a headache. My dear motocross rider you have a concussion.

Now as discussed in Concussions Part 1, we know that a concussion is a traumatic injury that causes a temporary mental disturbance. Now for most common injuries basic first aid should be induced to promote healing, but you may be asking yourself how exactly do I heal my brain? The most important step that any racer with a concussion can take is not returning to the race and resting their brain.

Once a concussion has occurred a “change in brain function occurs that can last anywhere from 24 hours to 10 days.” At this point you do not want to continue participation because of the possibility of sustaining a second injury during this healing time, which can lead to a more severe and quite possibly permanent injury. One possible injury that can occur is second impact syndrome. Second impact syndrome is a condition in which the brain has swelled rapidly from a second concussion that occurs before symptoms from the previous concussion have subsided.  Second impact syndrome can occur minutes, days, or weeks after even the mildest of concussions. Essentially if you return to quickly to activity then you put yourself at risk to sustain second impact syndrome. Second impact syndrome carries a mortality rate of fifty percent. With that said there needs to be immediate treatment at hospital that includes both a magnetic resonance imaging (MRI) and a computed tomography scan (CT scan).

In order to avoid second impact syndrome it is essential to understand how to manage concussions. Concussion management is based on the grading of the concussion. Below is a concussion management plan NOT a standard of care that is used by the Action Sports Medicine Foundation.

• Grade 1 Concussion:
  • First grade 1: remove from contest for evaluation; May return to race activity the same day if symptoms resolved within 20 minutes and are cleared by physician testing.*
    • Following a first grade 1 concussion, if the athlete has no symptoms with rest or exertion after a 20-minute period of observation the athlete can return to activity.
  • Second grade 1: remove from contest for evaluation; may not return to compete for that event; may return to race activity in 1 week if cleared by a physician testing* at the next race.
  • Third grade 1: remove from contest for evaluation; may return to race activity in 1 month if cleared by physician testing* at the next race. Highly recommended to wait a month before returning to racing and having a MRI/CT scan at the end of the month and return only if they are normal.

• Grade 2 Concussion:
  • First grade 2: remove from contest for evaluation; may not return to compete for that event. May return in 1 week if cleared by physician testing* at the next race.
  • Second grade 2: remove from contest for evaluation; may not return to compete for that event. May return in 2 weeks if a MRI/CT scan is normal and if the rider is cleared by physician testing* at the next race.
  • Third grade 2: remove from contest for evaluation; may not return to compete for that event. May return in 1 month if MRI/CT scan is normal and if the rider is cleared by physician testing* at the next race. At this point it would be wise to terminate the riding season if the rider has suffered their third grade 2 or the MRI/CT scan or abnormal.

• Grade 3 Concussion:
  • First grade 3:
    • Brief loss of consciousness (seconds): remove from contest for evaluation; may not return to compete for that event. Requires transfer to the hospital. May return in 1 week if cleared by physician testing* at the next race.
    • Prolonged loss of consciousness (minutes): remove from contest for evaluation; may return to compete for that event. Requires transfer to hospital. May return in 2 weeks if cleared by physician testing* at the next race.
  • Second grade 3: remove from contest for evaluation; may not return to compete for that event. Requires hospital transfer. May not return for a minimum of 1 month and must be cleared by physician testing*. Normal MRI/CT scan and neurology consult is necessary for return to activity.
  • Third grade 3: remove from contest for evaluation; may not return to compete for that event. Requires hospital transfer. Termination of competition for that entire season. MRI/CT scan with neurology consult required.

*Physician testing is a Standardized Assessment of Concussions (SAC) test that assesses mental status with various questions assessing orientation, memory, and concentration at both rest and exertion. Neurological test will be used to assess strength and sensation. Failure is based on the physician’s judgment.

The best way to prevent all of the problems that can arise with concussions is by wearing the proper equipment. Having a helmet that has been tested and approved by the Snell Memorial Foundation ensures the rider that have bought a helmet that has passed tests that can take the impact of riding. Make sure if you have a crack in your helmet or any other damage occurs then you need to replace the helmet.

Just remember for concussions the treatment that’s best is to get some rest.

Sources:
Arnheim’s Principles of Athletic Training by William E. Prentice

Action Sports Medicine Foundation

• Action Sports Medicine Foundation, ASMF, is a non-profit organization whose mission is to enhance the quality and availability of sports medicine to athletes participating in action sports. ASMF continually provided medical coverage to action sports most specifically to motocross. They can be found providing medical coverage at Ponca City mX, Mini O’s, Branson MX, and many other tracks.

Visit their website at www.asmfjax.com or contact Christine Chmielewski at  Christine@ASMF.com.

Kristina's other articles - Get Your Drink On, Concussions - Part 1

That's it for now, until next time, good luck with your training and remember, if you have a question, log on to the Virtual Trainer Expert Forum and have your question answered by a panel of experts. In addition, be sure and check out the Racer X Virtual Trainer archive section. Your complete one-stop information zone for motocross fitness.

1. 
   kelly andris October 05, 2010 at 9:15 pm

   I just wanted to ask you a question about concussions. I was at Ponca City, I help a kid from Chile and he was racing. I raced as well in the 30 plus and 40 plus expertos. I went over the bars in like the 3rd corner of the race, as people told me, because I don´t remember anything. They restarted the race because I was out for awhile I guess. My wife told me when she got there, I was talking and answering questions and aware of everything that was going on. I went to the ponca city emergency where ther did X-Rays on my Humerous that I broke and a Cat scan on my brain and I was awake talking to everybody.
   
   Now, my question. I don´t remember any of that. I remember i was going over the bars, but after that, after talking to my wife and finding out things, I don´t remember like 24- 36 hours after. I was watching races and talking to people when they came to see me, but I don´t remember any of that. I did not Have a Headache or haven´t had a Headache. Nothing has came back to me that I didn´t remember, But just wanted to know, would this be considered a Concussion? (Without a Headache?) should I go see a specialist? I really don´t feelbad , just after looking at different articles and not really knowing if the Doctors at Ponca even know what they were looking at, if I should do a follow up?
   
   thank you.
   
   Kelly dean !!
   
2. 
   Kristina Miller October 06, 2010 at 8:34 am

   Hey Kelly,
   
   I would say you definitely had a concussion. From the sounds of it you had antreograde amnesia, which basically means you can't remember things after the incident. Since you got a CAT scan at the hospital and if they said everything presented normal than you should be fine. Just know you definitley sustained a concussion and it is always easier to get the next one. Make sure your helmet is still in good enough condition to continue wearing it or you may want to replace it. Also if you feel you want to get checked out again, my philosophy that it is better to be safe than sorry. Good luck and thanks for the questions.
   
   Kristina Miller
3. 
   Tim Crytser October 06, 2010 at 9:09 am

   My advise is to see your primary care physician. Just because you did not or do not have headaches does not mean you did not receive a serious head injury. See your doctor and let him know what happened. He will most likely do nothing more than watch you, but it is always best him (or her) decide the best course of action.
   
   And REPLACE YOUR HELMET!
4. 
   rj October 08, 2010 at 2:19 am

   i have had several concussions up until the last one this last january. 3 days after impact i suffered blurred vision and strong migraines. Thereafter, the fourth day was so bad i vommitted and then went to the emergency room. the cat scan was negative for brain damage but now after a good 8 mos. I still have blurred vision followed by bad headaches and sometimes nausea. It is highly likely that I will have a headache at the end of the day.
   
   I am getting an mri next week along with some bloodwork. Are there any other things I could do? Is there anything out there to prevent this from getting worse or continuing? It is a real thorn to have to deal with this all the time.
   
   Thank you
   
   RJ
5. 
   Tim Crytser October 08, 2010 at 5:30 am

   RJ, at this point I think the best advice has to come from your Doctor. For us to speculate and give you recommendations without knowing anything about your history would be very irresponsible on our part. Sounds like something serious is going on, hence the need for the MRI.
   
   Now what we can do for you is after you have seen your Doctor and been evaluated, let us know what he said and we can help with questions or give advice on carrying out your Doctor's orders. Good luck and keep us up to date. Once you are cleared and given the green light, we will do everything we can to get you back in tip-top shape!