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Protect Your Head!
Preventing and treating head injuries

Head injuries are a common occurrence. Many of you may have had a family member or friend who suffered a head injury. Perhaps you may even have experienced a mild concussion yourself.

Head injuries can occur in many different settings. The most frequent and severe occur from car accidents and industrial accidents. These injuries are usually associated with other injuries to the body and can be life threatening. In sporting activities, although head injuries occur, most are not severe. This article will help you understand more about head injuries in sport, how to recognize them, and what to do if a friend or family member suffers one.

Not surprisingly, head injuries occur more often in collision sports such as football, hockey and boxing where especially designed, protective head gear is usually required for participation. It has been estimated that more than 250,000 head injuries occur yearly in North America from football alone! In ice hockey, head injuries happen after collision with other players, the ice surface or boards around the rink, and with a high speed projectile -- the puck! Boxing is the only sport in which the goal, in order to win, is to cause a head injury in the opponent, a ‘knock-out.’

In other recreational sports such as cycling, in-line skating and baseball, head injuries do not occur often. However, the chance of injury still exists and protective head gear should be worn. Safe participation in any recreational activity should include using the proper protective equipment in a controlled environment. In most sports this means wearing a proper fitting, safety standard approved helmet.

Concussions

The most frequent way a brain is injured is with a force striking the head. An example of this is a boxing glove striking the face of the opponent. A less frequent, but still common way the brain is injured is by the head striking a firm surface. An example of this is the cyclist, with no helmet, falling off a bike and striking his head on the pavement. When the hard skull is suddenly stopped on the hard surface, the brain continues to move inside the skull. The brain is injured by striking the hard bony surface of the inside of the skull.

A concussion is any alteration in mental status that occurs as a result of trauma. With these injuries, there is very little or no structural damage to the brain although an interruption in brain function has still occurred. Concussions can be mild, moderate or severe. A mild concussion can cause confusion, dizziness, unsteadiness and loss of judgment but no amnesia or loss of consciousness. These feelings are usually gone within a few minutes. A single, mild concussion alone will not interfere with future participation in sports. As well, it will not have an effect on long term health.

If the symptoms of confusion, dizziness, unsteadiness and loss of judgment persist beyond half an hour, the concussion is considered moderate or severe. The symptoms are more serious if there is loss of consciousness, memory loss, marked headache, nausea and vomiting and ringing in the ears. In a severe concussion, there is a prolonged loss of consciousness with a significant memory loss. If there is bleeding in the brain there may be seizures and paralysis. This is a true emergency.

What To Do?

Any person who receives a severe blow to the head and has symptoms of a concussion should be examined by a doctor as soon as possible. The doctor will ask how the injury occurred and about the symptoms. The examination will look for any signs that indicate brain injury. The severity of the head injury will be based on the symptoms, the mechanism of injury, and the physical exam.

From this point, the doctor may decide if further tests (e.g. imaging of the brain) or hospitalization is required. In most circumstances where the head injury is mild, no further tests or hospital stay are required. The person may be safely sent home in the company of a responsible person. The nurse or doctor will give instructions on what to do over the next 24 to 48 hours. The responsible person must be prepared to check the injured person regularly (often each hour) to ensure the symptoms have not worsened.

If a severe head injury has occurred and the person is unconscious, it is important to call for help immediately. This usually means calling 911, or activating the Emergency Response Department in your community.
A person who is not in immediate grave danger should not be moved in the meantime. A serious neck injury can often occur along with a severe head injury. Any movement by someone untrained may create more injury to the neck.

More Than One Concussion

What if you have had more than one head injury in a sport that you enjoy? How many concussions are too many? When is it safe to return to play after a concussion? What affect will these concussions have later in life? These are all complicated questions without clear answers.

Having no concussions or one mild concussion is the best situation of all. Having several concussions a year, from moderate to severe, over many years is the worst situation of all. This is seen in boxers who, later in life, suffer serious mental impairment and neurological disability.

Returning to play after a head injury depends on the severity of the injury. As a rule, the more severe the injury, the longer the time needed before it is safe to return to play. If a severe head injury does occur in a sport that carries a continued risk of further injury (such as football or hockey), serious thought should be given to retiring from that sport.
The benefits of physical activity far outweigh the risks of injury from participating. For the recreational athlete these risks are even further reduced by wearing properly fitting safety equipment. For many sports this means wearing a helmet designed for that sport. For parents of aspiring athletes, the best thing to do for your children is to provide them with the proper helmets, encourage them to wear helmets, and set an example by wearing one as well!

Play . . . But Wear a Helmet!