• In your opinion what is the most
difficult injury to overcome in
sports today? Why?
• We will analyze the causes of concussions
and the trauma that can be caused from a
concussion using notes and discussion
• Vocabulary: encephalon, concussion,
Central Nervous System
Central Nervous System (CNS)
• Brain (encephalon) and spinal cord compose
• CNS is protected by meninges, cranium, and
• CNS consists of gray and white matter and
weighs 3 to 3.5 lbs (adult).
• Brain has three basic components – cerebrum,
cerebellum, and brain stem.
• Neural impulses travel to and from the CNS via
12 pairs of cranial nerves and 31 pairs of spinal
Head Injuries in Sports
Even minor head trauma can result in serious
• Brain tissue is unable to repair itself.
• Any tissue loss results in some level of
• Severe injuries can result in death.
• Significant advances in understanding of
▫ Coaches can learn to recognize head injuries
and render first aid when necessary.
• Can occur in any sport at any level
• Research over who is most susceptible to
head injuries is ongoing
▫ Guskiewicz: 3 year study of head/ brain
injuries in high school and college football
Approximately 300,000 traumatic head or brain
Players with a head or brain injury had a 3x
higher risk of a second head injury
• Cheerleading highest risk of head injury in
▫ Most injuries resulting in catastrophic injury
• Injury rates dramatically increasing in soccer
Mechanisms of Head Injury
Direct mechanism of injury involves a blow to the
head that causes injury at impact site (coup
injury) or on the opposite side of the skull from
impact (contracoup injury).
▫ Contrecoup: associated injury occurs when the
head is moving and stops abruptly
▫ Example: when a tackle is made; brain is moving
in the skull then compressed on the side of the
head opposite the impact
Mechanism of Injury
• Indirect injury to the head results from
damaging forces traveling from other parts of
▫ blows to the jaw or face
▫ Rapid and violent movement of the cervical
Treat every head injury as if there is a neck
injury and vice versa.
A concussion is “a clinical syndrome
characterized by immediate and transient
impairment of neurologic function secondary
to mechanical forces.”
▫ Symptoms include unconsciousness,
disorientation, headache, amnesia
(anterograde or retrograde), dizziness, and
• There is some level of structural damage
• Brain cells not destroyed remain extremely
vulnerable to another trauma
BRAIN TISSUE DOES NOT REPAIR
• Variety of systems used
• Based on duration of unconsciousness and the
pressence or absence of post-traumatic amnesia
▫ Retrograde: unable to recall events prior to the
▫ Anterograde: unable to recall events after the
• Grade 1 (mild) involves no amnesia but are
difficult to identify.
• Grade 2 (moderate) involves loss of
consciousness for less than 1 minute and/or
PTA lasting longer than 30 minutes.
• Grade 3 (severe) involves loss of
consciousness for more than a minute and
PTA lasting more than 24 hours.
Grade 1 Concussion
• Most common
• Most difficult to identify
• Major distinction between Grade 1 and 2
(Cantu) is loss of consciousness and/or PTA
lasting longer than 30 minutes
Grade 2 and 3
• Usually have loss of consciousness
• Slow response to simple questions
• Distinction is amount of PTA
Second Impact Syndrome
Second Impact Syndrome (SIS) can be a serious
▫ Results when an athlete with a head injury
receives another head injury before the
symptoms of the initial injury have resolved.
▫ Involves rapid, catastrophic brain swelling.
▫ SIS can result in death.
Any athlete sustaining a head injury, no matter
how minor, should be referred to a physician
before being cleared to return to participation.