As with any injury in sports, the most important prevention is to have a plan before the injury occurs. In the heat of a wrestling match, parents and coaches sometimes become overwhelmed by the moment, rendering decisions based upon the score and the intensity. There is no place for uncertainty regarding closed head injuries and concussions.
The athletic trainer is usually the initial line of defense regarding further injury during athletic competition or practice, and the most qualified to render a decision as to the athlete’s ability to continue to compete. There are a number of sideline evaluations that must be done if a concussion is a potential diagnosis, and the sport of wrestling challenges the athletic trainer to render such an important decision due to its injury time limitation when blood is not involved.
Two specific tests that athletic trainer’s perform are the Standardized Assessment of Concussion (SAC) and the Balance Error Scoring System (BESS). These screenings will yield important information regarding the athlete’s capacity to resume wrestling. The facts demonstrate that only 10% of concussions include loss of consciousness, and some researchers believe it is considerably less based upon the athlete’s failure to report common concussion symptoms.
Common initial concussion symptoms include dizziness, balance deficits, headache, ringing in the ears, fatigue, slurred speech, general disorientation, vomiting and amnesia. Later symptoms include severe headache, irritability, sensitivity to light, personality changes and depression, memory and concentration deficits. Coaches and parents who know the athlete best can recognize many of the secondary symptoms due to personality changes, which should be reported to medical staff.
As a general rule, any athlete that is rendered unconscious should automatically be removed from competition until they have further tests by specialists, and are monitored for at least 24 hours for further symptoms, as initially there may be nothing that would suggest concussion. General CT Scans and MRI’s cannot be a determining factor as to resuming athletic competition, as they have proven to be less than sensitive to the subtle changes regarding concussion. Athletes with a prior concussion history are at greater risk.
Testing and retesting using conventional psycho-neurological testing is advised. It would be best if athletes, who are prone to potential concussion, including wrestlers, would proactively undergo such testing before the season, yielding a baseline for comparison. Return to sport should also include simulation of the stressful environment, including increased heart rate and blood pressure followed by a re-evaluation of symptoms. This physical exertion will sometimes demonstrate that the return of concussive symptoms signal that the athlete is not ready to resume normal training and competitive activity.
Vincent Hudson, PhD, DPT, ATC is a certified athletic trainer and a licensed physical therapist with 27 years of clinical and operational experience in the area of sports medicine. He has been employed at colleges in the Division I, II and III levels as well as the NBA and NFL. He currently is the Chief Operating Officer at OAA Orthopaedic Specialists in Allentown, PA.