“When in doubt, take them out.”
“There's always this battle, particularly in sporting events: What do you do if someone's had maybe a concussion, but you're not sure, and it's the big game, and maybe there's a recruiter from a college?” says Steven Flanagan, MD, chair of the Department of Rehabilitation Medicine at NYU Langone Health.
One of the biggest risks for athletes who have sustained a concussion is something called second-impact syndrome, or SIS. This is when someone gets a second head injury within a few weeks of the first, and it can result in serious complications such as brain swelling, shifting, and possibly death.
This is why it’s so crucial for athletes with head injuries to be taken out of the game or competition, and not return to play until given the OK from a physician. Of course, things can get complicated when you’re dealing with heightened pressure (“We have to win!”) or elevated emotions (“I’ll be devastated if you take me out!”).
Because of these nuances and pressures, some research suggests that close to 70 percent of athletes who had concussion symptoms continued to participate, according to the Centers for Disease Control and Prevention. That’s not great news.
It’s crucial for athletes to be honest since only they know how they truly feel. “The coach and the parents also need to be on the lookout. Is someone just so eager to get back on the football field or the baseball field or back into gymnastics that they're not being honest with their symptoms?” says Dr. Flanagan.
Because the answers aren’t always clear, Dr. Flanagan recommends the following mantra: “When in doubt, take them out.”
Additionally, it’s important for coaches to be able to recognize the symptoms of a concussion (also known as a “mild traumatic brain injury”). There are some telltale symptoms of a concussion that you can recognize in others, even if they’re claiming to be “fine.”
“That's probably the most important thing to do—recognize it when it happens,” says Dr. Flanagan. “If they've had a concussion, their balance may be off, their reaction times may be off. You're setting them up for another concussion.”
Dr. Flanagan is the chair of the Department of Rehabilitation Medicine at NYU Langone Health. He specializes in brain injury rehabilitation.
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There's always this battle, particularly in sporting events:
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What do you do if someone's had maybe a concussion,
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but you're not sure, and it's the big game,
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and maybe there's a recruiter from a college,
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and you want Joey or Susie to get that scholarship,
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but the real danger, particularly in adolescence,
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even though the risk is small, is second-impact syndrome.
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So if you get a second concussion,
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fairly soon after your first, there's this risk
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of having a devastating outcome,
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and you just need to avoid that at all costs.
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It's key that the athlete,
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if we're talking about athlete, is honest.
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Only they know how they feel.
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It's critical that we get honest answers, and the coach
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and the parents also need to be on the lookout.
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Is someone just so eager to get back on the football field
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or the baseball field or back into gymnastics
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that they're not being honest with their symptoms?
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When in doubt, take them out.
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Even if you're not sure, well maybe they really didn't have
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a concussion, but you have a little doubt, take them out.
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It's just the safest thing to do.
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And I would say that's probably the most important thing
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to do, recognize it when it happens.
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If they've had a concussion, their balance may be off,
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their reaction times may be off.
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You're setting them up for another concussion.
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So it really is important for coaches, for parents,
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other players, to recognize concussions
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particularly in those events and take them out.
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No one is gonna second-guess you,
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or if they do second-guess you, too bad.
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You've done what's right for that kid,
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because ultimately, the vast, vast majority of folks
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will recover from a single concussion.
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But boy, if they've had that second impact, all bets are off.
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A fact sheet for high school coaches. Atlanta, GA: Centers for Disease Control and Prevention, 2019. (Accessed on April 1, 2020 at https://www.cdc.gov/headsup/pdfs/custom/headsupconcussion_fact_sheet_coaches.pdf.)
Acute mild traumatic brain injury (concussion) in adults. Waltham, MA: UpToDate, 2020. (Accessed on April 1, 2020 at https://www.uptodate.com/contents/acute-mild-traumatic-brain-injury-concussion-in-adults.)
Bey T, Ostick B. Second impact syndrome. West J Emerg Med. 2009 Feb;10(1):6-10.
HEADS UP to school sports: coaches. Atlanta, GA: Centers for Disease Control and Prevention, 2019.
(Accessed on April 1, 2020 at https://www.cdc.gov/headsup/highschoolsports/coach.html.)