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Head Injuries

by Coach Seiji

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Head injuries to football players and the resulting lifelong problems are starting to be discovered. The same can happen in motocross if you take too many blows to the head!

Injuries and rehabilitation from them are realities of motocross.  Riders are pretty good with orthopedic injuries such as sprains but there seems to be a void of knowledge or guidelines in motorsports when it comes to concussions. It has always been interesting to me that receiving and executing therapy is pretty much a given for orthopedic injuries but NOT for brain injury.

The 2009 Annual Meeting of the American College of Sports Medicine featured many sessions dedicated to sports concussions, both in adults and children. The most recent information on assessment, post concussion care and return to play guidelines stemmed from the Third International Conference on Concussion in Sport which was held in Zurich in 2008. There was an enormous mass of information that I came away with from the conference. the most important of which I summerized below.

My practical take home messages are as follows:

  • A concussion is a disturbance in the function of the brain by a direct or indirect force to the head. It can have a variety of symptoms and may or may not involve memory loss OR LOSS OF CONSCIOUSNESS. You can have a concussion without "blacking out!"
  • Helmets are mostly designed to prevent skull fractures. Concussions are the result of the rapid deceleration of the skull/brain. The skull comes to a rapid stop but the brain keeps moving and impacts the inside of the skull.
  • RED FLAG symptoms- SEEK PROFESSIONAL MEDICAL ATTENTION IMMEDIATELY:
Headache - Very drowsy - Can't recognize people and places - Vomiting - Confusion - Seizures - Unsteady - Slurred speech
  • Use SCAT2 (Sports Concussion Assessment Tool). SCAT2 is a standardized post concussion evaluation where the athlete scores themselves on how they feel as well as observation by others. You give a copy of these results to any attending medical staff. There are also memory checks, cognitive and nuerologic screenings to be done by the attending medical staff so that you will have a record of the results. The SCAT2 is then done during the recovery process to aid in determining the severity of the concussion, level of recovery and return to play. A preseason SCAT2 test is also suggested to help in post concussion interpretation of scores. You can download a copy of the SCAT2 here: SCAT2 on coachseiji.com
  • The trend of the symptom score on the SCAT2 is what is important in assessing the post concussion recovery process. This is also a reason to do a preseason SCAT2.
  • The SCAT2 also has return to play guidelines in a symptom moderated, step by step format.
  • The first week of recovery is critical. The "average" recovery is 7 days. Balance related symptoms usually go away in 7-14 days but nuerocognitive symptoms may persist in more severe cases.
  • Congitive rest is as important as physical rest: rest your brain! No TV, video games, etc.
  • 75% of repeat concussions happen within 7 days of the original concussion and 92% happen within 10 days.
  • More concussions = more recurrent concussions. You are 3.5 times more likely to have a concussion if you have had 3 or more in 7 years and you are 4 times more likely to have symptoms that last more than a week.
  • Fatalities are caused by an intercranial bleed that was not caught or return to play when concussion symptoms persist.
  • New guidelines insist that as long as there are concussion symptoms, there is NO return to play.
  • There is NEVER a return to play the same day as a suspected concussion.
  • Second Impact Syndrome (rare) = rapid brain swelling and herniation caused by a second concussion that occurs before the first one has compeltely healed. Can be caused by even a minor brain injury. Children are at higher risk than adults. Mortality is 50% and survivors usually have long term effects similar to a severe brain injury.
  • Older athletes recover MUCH faster than younger ones. There is much more risk involved with younger athletes with sports concussions due to a brain blood flow mechanism that can be "short circuited" in younger athletes.
That covers the most poignant notes from my many sessions during the seminars on sports concussions. The purpose of this article was not to be the end all of sports concussion information; it is to spur on your own research for information. As I stated earlier, it has been surprising to me how much attention and effort orthopedic injuries receive in motorsports while brain injuries are handled with almost no therapy or guidelines. Be smart and treat your brain at least as well as you would treat a broken bone! Do your research and give concussions the respect they deserve. You only get one brain!

Seiji Ishii is the head coach of www.coachseiji.com. Coachseiji.com provides online coaching and personal training services to motorsports athletes. Coach Seiji has worked with both pros and elite amateurs including: Heath Voss, Ryan Clark, Austin Stroupe, PJ Larsen, Hunter Hewitt, Drew Yenerch, Jason Anderson, and Andrew Short. Learn more at coachseiji.com or contact Coach Seiji directly.

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. VT Signature

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