The WIAA (Wisconsin Interscholastic Athletic Association) is an organization that provides support and guidance for middle schools and high schools, both public and independent. The WIAA oversees all organized athletics across the state, runs state-level tournament competition and provides for adequate athletic administration and coaching resources for schools involved in the association.
For more information on the relationship that NEW Lutheran High has with the WIAA, please contact our Athletic Director, Jared Gosse, at firstname.lastname@example.org.
CONCUSSION INFO FROM WIAA WEBSITE
CONCUSSION INFORMATION - When in Doubt, Sit Them Out!
A concussion is a type of traumatic brain injury that interferes with normal function of the brain. All concussions are brain injuries. The WIAA recommends avoiding the use of nicknames like “ding” or “bell ringer” to describe concussion because those terms minimize the seriousness of concussion.
A concussion is most commonly caused by a direct blow to the head, but can also be caused by a blow to the body. Even what appears to be a mild blow to the head or body can result in a concussion. It is important to know that loss of consciousness is not required to have a concussion. In fact, less than 10% of athletes lose consciousness.
A concussion is a complex physiologic event that causes problems with brain functioning (energy use and communication between nerves), but does not cause swelling or bleeding that affects brain structure. Therefore, CT/CAT scan and MRI are usually normal in athletes with concussion. Imaging studies are not indicated for most concussions, but may be needed in some instances to rule out more severe injuries, like brain bleeds.
Research has shown that adolescent concussions take longer than previously thought to heal, with 20% of high school athletes taking over 4 weeks to fully recover. Athletes must be fully recovered before considering medical clearance to return to full participation.
There are unique concerns surrounding concussion in high school sports:
1) Adolescents get concussions more often than collegiate and professional athletes
2) Adolescents take longer than adults to heal from concussion, unlike muscular-skeletal injuries
3) Most high schools may not have access to a team physician or an athletic trainer for all of their teams & activities, thus the responsibility for identifying a possible concussion falls on athletes, coaches and parents
4) High school players may try to hide symptoms or be reluctant to admit their symptoms due to fear of removal from play
High school injury surveillance research based on injury rates in practice and games has shown that the following sports have higher risk of concussion: Football, Boys & Girls Soccer, Boys & Girls Ice Hockey, Boys & Girls Lacrosse, Wrestling, Girls Field Hockey, Competitive Cheer, and Boys & Girls Basketball.
Noticeable in this data is that the risk for girls is much higher than boys in the same sports; in fact, soccer & basketball carry twice the risk for concussion in girls than boys. It is unclear why girls appear to have a higher risk of concussion.
Most importantly, concussion can happen to anyone in any sport. Concussions also occur away from organized sports in physical education class, on the playground, while skiing or snowboarding, and when involved in a motor vehicle collision.
Everyone involved with high school athletics must be alert for potential injuries on the field and be able to recognize signs and symptoms of concussion. While coaches are not expected to make a diagnosis of concussion, coaches are expected to be aware of possible injuries and understand that their athletes may have a concussion. Any athlete with a suspected concussion should be held out of all activity until medically cleared by a healthcare provider. It is important for athletes and coaches to communicate possible injuries to the athletic trainer, parents, and teachers.
Schools should educate their athletes, coaches and parents in the preseason about the seriousness of concussion and the importance of athletes honestly reporting their symptoms and injuries.
SIGNS AND SYMPTOMS
Signs are what can be seen by others, like clumsiness / stumbling off the field. Symptoms are what the injured player feels, like a headache. Remember, athletes should report their symptoms, but they may not unless they are directly asked about how they feel. Even then, it is important to consider that athletes may not be telling the truth.
These are some SIGNS concussion (what others can see in an injured athlete):
• Dazed or stunned appearance
• Change in the level of consciousness or awareness
• Confused about assignment
• Forgets plays
• Unsure of score, game, opponent
• Answers more slowly than usual
• Shows behavior changes
• Loss of consciousness
• Asks repetitive questions or memory concerns
Concussion SYMPTOMS are often categorized into four main areas:
1. Physical – This describes how they feel: headache, nausea, vomiting, dizziness, tired and loss of consciousness (which is uncommon in concussion). Vision and balance problems are also recognized as potential signs and symptoms of a concussion
2. Thinking – Poor memory and concentration, responds to questions more slowly and asks repetitive questions. Concussion can cause an altered state of awareness and thinking
3. Emotions – A concussion can make a person more irritable or sad and cause mood swings
4. Sleep – Concussions frequently cause trouble falling asleep and may wake athletes up overnight, which can make them more fatigued throughout the day
Injured athletes can exhibit many or just a few of the signs and/or symptoms of concussion. However, if a player exhibits any signs or symptoms of concussion, the responsibility is simple: remove them from participation. An athlete should never return to play on the same day. “When in doubt sit them out.”
It is important to notify a parent or guardian of any athlete with a suspected concussion. All athletes with a concussion must be evaluated and receive written medical clearance by an appropriate health care provider before returning to practice (including conditioning and weight lifting) or competition.
Some injured athletes may require emergency care & necessitate the activation of the Emergency Medical System (911). If you are uncomfortable with the athlete on the sideline or unable to ensure they are going home to a safe environment, it is reasonable to activate EMS/911. The following are other examples to activate EMS:
1) Loss of consciousness, as this may indicate more severe head injury
2) Concern for cervical spine injury
3) Worsening symptoms
4) Decreasing level of alertness
5) Unusually drowsy
6) Severe or worsening headaches
9) Difficulty breathing
If you suspect a player may have a concussion, that athlete should be immediately removed from play. The injured athlete should be kept out of play until they are cleared to return by an appropriate health care provider. If the athlete has a concussion, that athlete should never be allowed to return to activity (conditioning, practice or competition) that day. Athletes with a concussion should never be allowed to return to activity while they still have symptoms.
A player with a concussion must be carefully observed throughout the practice or competition to be sure they are not feeling worse. Even though the athlete is not playing, never send a concussed athlete to the locker room alone, as the athlete might not have the wherewithal to understand and report worsening symptoms. Never allow the injured athlete to drive himself/herself home.
Most concussions are temporary and completely resolve without causing residual or long-term problems. About 20% of high school athletes will take longer than a month to recover. This prolonged recovery is commonly known as Post-Concussion Syndrome (PCS). Common PCS symptoms include headache, difficulty concentrating, poor memory, mood changes and sleep disturbances. This prolonged recovery often leads to academic troubles, family and social difficulties.
Allowing an injured athlete to return too quickly increases the risk for repeat concussion. Repeat head injury while still recovering from a concussion may cause Second Impact Syndrome. This is a rare phenomenon occurring in young athletes that leads to rapid brain swelling, brain damage and potentially death.
Repeat concussions may increase the chance of long-term problems, such as decreased brain function, persistent symptoms and potentially chronic traumatic encephalopathy (a disorder that cause early degeneration of the brain). It is felt that these long-term complications are very rare in high school athletes, and the risk can be minimized greatly by proper reporting and care of every concussion.
Return to Learn
A major concern with concussion in high school students is that concussion can negatively affect school performance and grades. Symptoms (headache, nausea, etc.), poor short-term memory, poor concentration and organization may temporarily turn a good student into a problem student. The best way to address this is to decrease the academic workload, and potentially taking time off from school or going partial days (although the time missed should nearly always be less than 5 days). Injured athletes should be allowed extra time to complete homework and tests, and they should be given written instructions for homework. New information should be presented slowly and repeated. Injured athletes will need time to catch up and may benefit from tutoring. If an athlete develops worsening symptoms at school, he/she should be allowed to visit the school nurse or take a rest break in a quiet area. The school and coaches should maintain regular contact with the injured athlete’s teachers and parents to update progress.
All injured students should be removed from PE class until medically cleared.
Athletes with a concussion must return to full speed academics without accommodations before returning to sports (practice and competition).
Other Treatment Strategies
Relative rest remains an essential component of concussion treatment. It is helpful for parents to decrease stimulation at home by limiting video games, but a reduction in computer time, phone time, and TV/movies may also be helpful. “Cocoon therapy”, or avoiding all brain stimulation, has been shown to negatively impact recovery and is no longer a recommended treatment style..
Physical activity may be beneficial for recovery of injured athletes. However, high-level activity (weight lifting, practice level training and conditioning) should still be avoided. Simple physical exertion, like walking or stationary biking, that does not worsen symptoms may be done for short periods of time. Any post-injury exercise plan should be authorized and overseen by an appropriate health care provider.
An athlete’s concussion can interfere with work and social events (movies, dances, attending games, etc.). Good hydration and dietary habits and good sleep habits (8-10 hours per night) are important parts of the recovery process. There are no medications or supplements that help speed the recovery process.
Neuropsychological testing has become more commonplace in concussion evaluation as a means to provide an objective measure of brain function. Testing is currently done using computerized neuropsychological testing (example: ImPACT, Cognigram) or through a more detailed pen and paper test administered by a neuropsychologist. It is only a tool to help ensure safe return to activity and not as the only piece of the decision making process.
If neuropsychological testing is available, ideally a baseline or pre-injury test is completed prior to the season. This baseline should be done in a quiet environment when the athlete is well rested. It is felt that baseline testing should be repeated every one to two years for the developing adolescent brain. Multi-modal baseline evaluation assessing baseline symptoms, cognitive functioning, visual tracking, reaction time, and balance are ideal.
If there is no baseline available, the injured athlete’s computerized test scores can be compared to age established norms. This requires a provider experienced in the use and interpretation of computerized testing. The WIAA feels that neuropsychological testing can be a very useful tool with regard to concussion management.
RETURN TO PLAY
In order to resume activity, the athlete must besymptom free and off any pain control or headache medications that they were not taking prior to the concussion. The athlete should be carrying a full academic load without any significant accommodations for 1-2 days. Finally, the athlete must have written medical clearance from an appropriate health care provider.
The program described below is a guideline for returning concussed athletes when they are symptom free. Athletes with multiple concussions and athletes with prolonged symptoms often require a prolonged or different return to activity program and should be managed by a physician that has experience in treating concussion.
The following program allows for one step per 24 hours. The program allows for a gradual increase in heart rate/physical exertion, coordination, and then allows contact. If symptoms return, the athlete should stop activity and notify their healthcare provider before progressing to the next level.
STAGE ONE: Daily activities that do not increase symptoms (gradual reintroduction of school, work and walking).
STAGE TWO: Light aerobic exercise: slow to medium pace jogging, stationary cycling. No resistance training. This allows for increased heart rate.
STAGE THREE: Sport-specific exercise: moderate to higher intensity running or skating drills, but no activities with risk of head impact. This allows for increased heart rate and agility/movement.
STAGE FOUR: Non-contact training: Higher intensity aerobic fitness, and non-contact/non-collision team training drills (e.g., passing drills). May begin progressive resistance training. This increases coordination and thinking during sport.
STAGE FIVE: Full contact practice. Following medical clearance, participate fully in normal training activities. This restores confidence and allows coaches to assess functional skills.
STAGE SIX: Full clearance / Normal game play.
PREVENTION / RISK REDUCTION
There is nothing that truly prevents concussion. Education and recognition of concussion are the keys in reducing the risk of problems with concussion.
Wisconsin State Concussion Law (Act 172) was passed in 2011. This law mandates distribution of preseason educational information sheets to be signed by coaches, athletes and parents. It also recommends immediate removal of any athlete with a suspected concussion and no same day return to play. Finally, all injured athletes require written medical clearance from an appropriate health care professional. Research has indicated that the state law has helped improve education and awareness of concussion.
Proper equipment fit and use may reduce the risk of concussion.
However, helmets do NOT prevent concussion. They are used to prevent facial injuries and skull fractures. Most importantly, proper technique for hitting/contact are vital, for example, athletes that lower their head while making a football tackle have a significantly higher risk for concussion and neck injuries. Athletes should never lead with their head or helmet. Studies have shown that soccer headgear and mouthguards do not decrease concussion risk, although mouthguards are proven to decrease dental and facial trauma.
All schools should have an Emergency Action Plan. This plan can be used for any medical emergency from a concussion to a neck injury to anaphylaxis (severe allergic reaction). There should be an emergency action plan for every practice and competition area which should be practiced yearly.
The WIAA encourages every member school to promote concussion education and bring about a positive change in concussion culture by discussing this topic with all teachers, coaches, athletes and parents. We recommend a preseason discussion with athletes and families to set forth expectations for what will happen if a student has a concussion and the steps the student must go through to return to play. Coaches should use in-season concussions as “teachable moments” to remind teammates about the importance of reporting their injuries and supporting their injured teammate through the recovery process.
Further reading and additional education material can be obtained through the following locations:
www.nfhslearn.com (Concussion in Sports Course)
www.cdc.gov (Heads Up Tool Kit)
www.healthykidslearnmore.com (Concussion Return to Learn Course)