CONCUSSION + INJURY PREVENTION BASICS

CONCUSSION + INJURY PREVENTION BASICS - TEACHER NOTES

HOW TO USE THESE TEACHER NOTES

Description of this Class for Parents and Caregivers

Description of this Class for Parents + Caregivers — Español

Activity: Concussion + Injury Prevention Crossword

INTRO FOR EDUCATORS 

As kids get older, some engage in more risk-taking behaviors, others in more intense athletic competition, and a decent number do both. As a result, their risk of concussion and injury increases. 

Concussions––which are, in the simplest terms, bruises of the brain––are the most common form of mild brain injury. They affect somewhere between 1-2 million kids per year in the US alone (depending upon the information source), and nearly 7% of all US kids have had one at some point. 

This lesson is designed to equip students with knowledge about how to prevent concussions, and also how to recognize them and minimize damage when they do occur. Many of these students will say they feel pressure to ignore symptoms of concussion, instead getting back on the field or court immediately after hitting their head. But the evidence is overwhelming that this is a bad call: kids deserve to know that continuing activity can worsen the symptoms, prolong recovery, and put them at risk for a second concussion before the first has fully healed––a potentially catastrophic situation. If you’re interested in reading some of the data, look at this article about removal from play and recovery time from Pediatrics, this one reviewing school protocols from BMJ, and this one about the benefits of physical activity after symptoms are completely resolved. If summary articles are more up your alley, read this one from Harvard Health or this one from Nemours which can be read by the students, too! 

The lesson also covers injury prevention in general, because head bonks are far from the only trauma kids encounter. Rather than cover a long list of potential issues (that come in the high school injury lesson), this teaching focuses on determining whether you can take care of a given injury on your own or it's better to seek help––a life that skill becomes evermore critical as kids grow up. 

If you are looking for more information, here’s some of the science behind sports-related concussion rates and here’s a nice explainer of what concussion actually does to the brain and here’s a summary about traumatic brain injury. Or give these episodes of the This Is So Awkward Podcast a listen: Understanding and Managing Concussions and Understanding Teens and Headaches and Weightlifting and Cross Training in Teens.

 

ICE BREAKER

What's the most common injury you hear about? Has it ever happened to you?

 

LEARNING OBJECTIVES 

• Define concussion 
• Learn how to recognize, treat + prevent concussion
• Learn how to prevent + manage other common injuries 

 

WHAT IS A CONCUSSION?

A concussion is a bruise on the brain.

The brain is a solid but soft organ protected and surrounded by the hard, bony skull. In between the brain + skull is a cushion of fluid. 

• If the head is hit––in an accident or a tackle or after a slip and fall––the brain bangs against the bony skull. 
• The fluid surrounding the brain reduces the impact of the brain knocking against the skull––that fluid is called cerebrospinal fluid or CSF. 

Depending on the injury, the brain can bruise, swell, or be totally fine. It's always a smart idea to get checked out if you hit your head. 

 

WHAT HAPPENS IN THE BRAIN

Bruises (medical term: contusions) can happen at the point of impact or opposite from the point of impact

• If you run into a pole and your forehead smacks against the pole, you can develop a bruise directly underneath the forehead.
• If you are tackled and your head jerks forward, then back, you can injure different parts of the brain: either directly underneath the skull, where the head made impact OR at the back of the brain, because the brain can bounce against the skull opposite the point of impact (called an acceleration/deceleration injury).

Whenever a part of the body gets bruised, the area becomes swollen as water and inflammatory cells come to the area. Bruises on the brain can cause swelling, too. 

• Because the skull is a hard, fixed shell, there’s nowhere for brain swelling to go, unlike a bonk on the arm or leg where the swelling can push out against the soft skin. 
• The brain expands with swelling, but the skull does not.
• The brain can get squeezed into a suddenly small space.
• This can cause symptoms.
• Swelling in the brain can lead to increased pressure inside the skull, which is dangerous.

 

 

HOW MANY IS TOO MANY?

The answer to how many concussions is “too many” really depends upon the intensity and frequency of those concussions. One major concussion can send someone to the hospital, while some minor concussions might go completely unnoticed. In fact, some people have lots of concussions and never know it. The 2 biggest concerns are:

1. Having a second concussion before you’ve healed from the first. When there’s been a recent concussion, there might still be some left-over swelling in the brain from a partially-but-not-entirely healed concussion. Swelling on top of more swelling inside of the skull can lead to a medical emergency. This is why people with concussions are told to rest.
2. Having multiple concussions that cause chronic brain injury. Chronic traumatic encephalopathy (CTE) is a disease found many years after repeated head trauma. CTE is thought to be related to the number of concussions a brain has experienced over time. It has been found most commonly in athletes who played high-contact and tackle sports like football.

 

RECOGNIZE A HEAD INJURY 

When the head is hit and the brain gets bruised, if there’s enough swelling to increase the pressure inside the skull, this can cause symptoms like:

• Headache
• Nausea or vomiting
• Blurred vision
• Difficulty concentrating
• Sleepiness
• Confusion

Sometimes symptoms are immediate; other times they take a few minutes or even hours to appear. Pay attention and get help if you hit your head and then one or more of these symptoms appears later in the day or night. 

If you have 6 extra minutes, watch this video linked in the slide from Dr. Mike: Concussions 101 

 

TREATING A CONCUSSION

The treatment of a concussion entirely depends upon how severe it is. If you hit your head and have any symptoms at all, the smartest move is to stop playing and get some help from a trusted adult and a healthcare provider.

• You will almost certainly be told you need to sit out of play until your symptoms are better. 
• This is annoying advice, but it is much better for the long term health of your brain to let the bruise heal.
• Even if you don’t have symptoms, you may wind up getting checked––better safe than sorry!

There’s a lot of debate about what people should or shouldn’t do while healing. These are the different strategies that might be recommended by a healthcare provider:

• Everyone agrees that a person with concussion symptoms should not return to play.
• Some doctors recommend brain rest: taking a break from anything that makes the brain do hard work.
• Some say to reduce screen time while healing or even avoid screen entirely––if screen use causes a headache or another symptom, definitely turn it off.
• Some say to keep the lights low and noise to a minimum.
• Others say you only need to limit things like screens, lights, and sounds if they make symptoms worse.
• The best advice is always to talk to a healthcare provider who can guide you.

If you have 10 minutes, watch this excellent summary video from Dr. Mike called Concussion Management and Return to Learn

Or look at the CDC guidelines: HEADS UP

 

PREVENTING A HEAD INJURY

Concussions are (sometimes) preventable!

There are some easy things to do to reduce the risk of getting a concussion:

• Wear protective headgear: Helmets provide an extra layer of cushion on the outside of the skull. Wearing one softens the blow and minimizes brain bruising 
• Avoid obvious risks: Don’t jump out of a tall tree for kicks and don’t forget your seatbelt in the car (they minimize head injuries in accidents by strapping you into the seat, so you cannot fling forward and bang your head)
• Minimize headers: The research suggests that younger soccer players should avoid headers – the research for older players is ongoing. In football, the rule which bans leading with the head came from data showing increased risk for concussion.

 

 

MANAGING INJURIES

Apart from concussions, the body can be injured in many different ways. Physical activity is super important, whether it’s playing sports, going for a bike ride or swimming in the ocean. Injuries happen when the body is moving… and even sometimes when it’s not. 

For ANY injury:

• Get help from an adult if something feels wrong.
• Don't downplay or ignore symptoms.
• Don't push yourself when you're not feeling 100%.

If you're interested in learning how to manage injuries, get trained in first aid + CPR.

Any injury involving the head should trigger adult involvement. Injuries to any part of the body that make it hard to move around or cause pain during a routine activity should also be shared with an adult, like sprains or bone injuries. Never downplay your symptoms in an effort to get back on your feet. 

• A nasty scrape that may require stitches 
• A hit to the eye resulting in vision changes
• Anything that causes vomiting
• Cuts that won’t stop bleeding
• Mouth, jaw, or tooth pain
• And yes, a head bonk that might have caused a concussion

Know how to use the contents of a first aid box. It’s important to learn what sterility means and why it’s important. Always clean cuts before covering them with a bandage and always have a trusted adult or healthcare provider help when available. 

And while an injury is healing, if things start to get worse instead of better, get help from an adult. Here are some examples:

• More pain
• Increased redness
• More swelling 
• Something that just doesn’t feel right…

 

PREVENTING INJURIES

The best way to handle an injury is to not get one at all! Injury prevention is actually pretty easy. Listen to your body and notice when things don’t feel right. 

If something hurts in a new way, don’t ignore it. Instead, stop what you’re doing and let a trusted adult know

Don’t work out, play in a game, or engage in an activity when you’re not feeling well because injuries are more common when a person is:

• Hungry
• Tired
• Lightheaded
• Coming down with a cold
• Actively down with a cold
• Sleep deprived
• Otherwise less than 100%

Be smart: some of the most common injuries happen when a person engages in an activity that they know they really shouldn’t do. 

• Jumping out of the tall tree 
• Skateboarding while holding onto a moving vehicle 
• There are a zillion other examples of risky behaviors that can lead to a wide range of injuries, some of them life-altering. 

Overuse injury is a specific type of injury that happens when the same body part is used repeatedly. Playing the same sport every day, all year round can create this problem. Here’s how to avoid it:

• Crosstrain by playing different sports or doing different activities to strengthen various muscles, joints, and ligaments––most studies shows that the most accomplished athletes (the pros) cross-trained through their teen years, often competing in multiple sports.
• Vary workouts to include strength training, cardiovascular activities, and STRETCHING (which protects joints and muscles from injury)
• Don’t ignore or hide injuries, because untreated injuries only get worse, not better, with more use. Social media-hyped diagnoses and treatments are not the way to go here

Overuse can also be mental – that’s called burnout. Mental exhaustion comes from doing the same activity over and over. This is preventable! Try some or all of the following:

• Take breaks from a single sport––no one would eat the same food every day, for every meal, forever, even if it’s their favorite.
• Find other activities that are fun and get you moving in new ways. 
• Make time for recovery, allowing the body and brain to refuel after intense physical exercise – this includes hydration, sleep, nourishing food, and a mental break from intense training or competition. 

Overtraining also increases the risk of injury. Watch this 6 minute video from SciFit to learn more: Overtraining and how to deal with it

ACTIVITY: Open this PDF to access directions and materials to complete a Concussion + Injury Prevention Crossword

 

 

SUMMARY 

Whether it’s about concussions or other injuries, understanding (1) how to prevent them, (2) what’s happening in the body when they do occur, and (3) when to get help are all super important. Listen to your body!

 

LET'S TALK ABOUT IT

If you think you have a concussion...

1. What should you do next?
2. What might get in the way of you telling an adult?
3. Who are the adults you're comfortable going to?

 

SCENARIO

Diego has had ankle pain for the last two weeks. There is a big game coming up, and he doesn't want to tell anyone about his ankle in case he has to miss the game. He feels a lot of pressure to do well for his team, his coaches, and his parents. What would you advise Diego to do?