Concussion in gymnastics
Patria Hume explains the signs and symptoms and treatment of concussion
What is concussion?
Concussion is a form of brain injury caused by a temporary disturbance in the way the brain works. Concussion can occur following a sudden violent movement of the head, for example when the head hits the ground after falling off the bars. Most damage is caused by rotation and acceleration (e.g. a spinning of the head caused by a blow to the side of the head). The brain accelerates and decelerates inside the skull and can become bruised by colliding with the inside of the skull. Concussion may occur with or without loss of consciousness. Concussions commonly occur in falls.
How does concussion affect brain function?
After the initial injury, the way the brain functions is disrupted. It is important to realise that the symptoms of concussion may not appear immediately. The normal electro-chemical balance within the brain goes 'haywire'. This happens in a cascade and is the reason that a gymnast can appear lucid directly after a head injury but become increasingly confused after a couple of minutes. It takes energy (from the oxygen and fuels carried in the blood) to pump the chemicals back into their proper balance within the brain. What makes things especially tough on the brain cells is that when a concussion occurs, the blood flow to the brain decreases so that excessive bleeding into the brain does not occur. So at the time the brain cells are crying out for extra energy to allow them to return to their normal state, the amount of energy getting through to them is lower than normal. While the brain cells are in this energy-starved state they are particularly susceptible to any further injury. Many of the cells that would recover if the brain were allowed enough time to heal will die if the brain is further injured while in this vulnerable state.
What are the signs and symptoms of concussion?
A concussed gymnast may show some of the following signs:
Concussed gymnasts may be unable to focus, may be disorientated (e.g. walking in the wrong direction), uncoordinated (stumbling or unable to walk) or emotionally confused (e.g. crying for no apparent reason, aggressive).
What should I do if a gymnast is concussed?
If you are unsure about whether a gymnast has sustained a concussion, err on the side of caution. The diagnosis should be 'concussion until proved otherwise by a proper medical diagnosis'. Think safe, and take the gymnast out of the competition or practice immediately.
The amount of force required to knock someone unconscious is similar to that which is capable of causing a spinal injury. If a gymnast is knocked unconscious, assume they have a spinal injury and follow the following guidelines:
Does getting concussed change the risk of getting further concussions?
Receiving a concussion generally increases the risk of being concussed again - often through less serious injury than would normally be required to cause a concussion.
What happens if a gymnast sustains a second concussion before the first is fully healed?
A second concussion before a first one has fully healed can result in serious, long-term disturbances in brain function. These can affect a gymnasts' ability to learn, work and generally get by in the world. Symptoms are changes in mood or personality, such as irritability, forgetfulness, extreme fatigue or anger. In rare cases a second serious head injury can result in the death of the person, particularly for people under the age of 18.
What are the stand-down requirements if a gymnast has been concussed?
New Zealand gymnastics have stated that any gymnast who has been concussed may not participate in practice or competition for a period of three weeks from the time of the injury, unless they have a medical clearance from a Doctor (a qualified neurological specialist should determine if the gymnast is symptom-free). All gymnasts must obtain a medical clearance before they resume participation. A team official should see the clearance statement before the gymnast is permitted to start participating again.
Can you reduce the risk of concussion?
The best way to reduce the risk of concussion is to ensure that trained spotters are available during training and competition to prevent falls. Gymnasts should also be progressed through skills and not attempt skills that they are inadequately prepared for.
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About the Author
Patria Hume is Director of the New Zealand Institute of Sport and Recreation Research at Auckland University of Technology, New Zealand. Patria`s research focuses on reducing sporting injuries and improving sport performance by investigating injury mechanisms, injury prevention methods, and biomechanics of sports techniques. Patria represented New Zealand in Rhythmic Gymnastics as a gymnast for six years. As a coach Patria`s gymnasts have competed at Olympics and have won medals at Commonwealth Games.
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