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CONCUSSION
Author: Chad Lerma
Two fighters exchange quick blows. The referee calls for a break, and a point is awarded. One fighter emerges from the clash and stumbles but catches himself. Then he looks around in a state of confusion, unsure of where to line up or what to do.
In another match, two grapplers square off. One fakes high then lunges in and drags his opponent to the ground with a single-leg takedown. As they stand up for another go, the fighter who was taken down seems disoriented and can’t remember what just happened to him.
Both martial artists are suffering from a concussion.
Relative to other sports, the martial arts are safe. In fact, they have a lower rate of injury than football, basketball, soccer and baseball. Studies have also shown the martial arts to be safer than golf, dancing and general exercise. Despite that laudable safety record, serious injuries do happen. Concussions are among the most common, occurring more than five times as frequently as fractures of the long bones.
It’s important for all martial artists to understand the risks of concussion, know its causes and prevention, be able to recognize the signs and symptoms, and know what to do when someone sustains one. That’s especially true for instructors and higher-ranked practitioners who have a responsibility for the safety of less-experienced students.
Cause and Symptoms
Concussions in the dojo most commonly result from a blow to the head inflicted by a punch or kick, but they can also follow instances in which the head hits the floor during a fall or takedown maneuver. In fact, any jarring of the head that occurs with sufficient force is capable of producing one.
Many people mistakenly believe that a concussion occurs only when a person is knocked unconscious.
While it’s true that anytime someone is knocked out he has sustained a concussion, unconsciousness does not always result. A concussion is defined as an alteration in mental status resulting from trauma, which may or may not involve a loss of consciousness. Symptoms include confusion, disorientation, dizziness, headache, difficulty concentrating, visual disturbances, difficulties with balance or coordination, and memory loss. Unconsciousness and pronounced memory loss generally indicate a more severe injury.
One of the difficulties associated with recognizing a concussion is that the injured person usually doesn’t identify himself as having sustained one. Often the diagnosis is made by others who notice the person behaving strangely, looking dazed, forgetting what he’s supposed to do or wandering away from the task at hand.
Immediate Action
So what should you do if you think someone has been hit in the head a little too hard? It’s essential that a person suspected of having sustained a concussion be evaluated by competent medical personnel. If the person is unconscious and unresponsive, call an ambulance right away. Assume he has a neck injury until proved otherwise, and take precautions to avoid aggravating the injury. Airway, breathing and circulation should also be assessed, and CPR should be performed if necessary.
Identifying a concussion in a person who has not lost consciousness can be more difficult. Questioning him as to where he is, who his opponent was, what the date is or what recently took place in his life may be helpful. Another tactic for revealing memory difficulties involves naming three objects and asking him to repeat your words.
If you suspect a concussion has resulted, you need to remove him from the activity and prevent him from returning until he’s cleared by his doctor. Generally, a person who has suffered a mild concussion with no loss of consciousness may return to the activity if symptoms clear up within 15 minutes, but he should rest for an additional 15 to 20 minutes before stepping back on the mat. Do not allow him to resume activity while concussion symptoms are present. Anyone who suffers a loss of consciousness—even a brief one—must be transported to a hospital for further evaluation.
The Alternative
Serious risks are associated with a premature return to martial arts training after a concussion. The worst is called second-impact syndrome.
It occurs when someone who’s suffering from the effects of a concussion receives a second blow to the head. The second impact may be relatively minor, but it can still cause the brain to swell and ultimately lead to death. One or two cases of secondimpact syndrome occur each year during sporting events; most are due to injuries sustained while participating in football.
Long-term or permanent injury to the brain is another concern. In the past, it was thought that once a person recovered from a concussion, there were no long-term effects. We now know that trauma to the brain can be cumulative. An extreme example of this is the punch-drunk boxer who may have speech and coordination problems, tremors, attention deficits and psychiatric symptoms. A study of retired professional British boxers revealed that 17 percent showed evidence of brain injury due to boxing.
Multiple concussions increase the likelihood of permanent injury, especially if they occur close together in time. Having received a concussion also increases the likelihood of receiving a subsequent one by a factor of four to six.
A concussion may also result in post-concussion syndrome, in which a headache, irritability, inability to concentrate, dizziness, decreased memory and/or fatigue are experienced.
These symptoms usually disappear within six weeks to eight weeks.
An Ounce of Prevention
Preventing concussions is the smartest way to deal with the problem, and that begins with proper training and supervision. It has been shown that inexperienced martial artists have the highest rate of injury. Preventive measures should include drills that increase the students’ control of offensive moves and the efficiency of defensive tactics such as blocks. They should also be taught the importance of protecting their head.
Avoiding, rather than absorbing, punches and kicks can decrease the risk of sustaining a concussion.
Establishing firm rules that specify the type of contact that’s permitted and limit the use of high-risk techniques will also reduce the danger. Allowing only “touch contact” to the head during practice forces students to control their techniques. Remember that moves such as the spinning hook kick—and spinning kicks in general—are inherently difficult to control and should be considered risky.
It’s imperative that sparring situations be closely supervised and that the rules be strictly enforced. Instructors need to be diligent in their roles as supervisors. Outside of competitive situations, most injuries occur in the presence of supervision but are usually unobserved by the supervisor.
Protective headgear should be worn whenever a risk of contact to the head exists. Mouth guards not only protect the teeth but also decrease the jarring force of blows to the head. The floor should be padded to help protect students in case of a fall.
In general, certain situations are associated with increased concussion risk, including competition, sparring and full-contact drills. Competition increases the risk of serious injury three to 20 times.
It should be noted that headgear decreases the frequency of injuries such as fractures and lacerations but may not protect against concussions.
And hand and foot pads are more likely to protect the attacker than the defender. Greater incidence of injury to the head has been found in tournaments where hand padding was worn. That may be because of a reduced emphasis on control. Ten-ounce boxing gloves can lessen the force of blows to the head, but many martial arts gloves will not. Studies have shown that the ability of martial arts gloves to soften the force of a blow can decrease after as few as five strikes. Another study found that the force of kicks actually increased when foot pads were used. The use of protective gear does reduce the overall risk of injury, but it should not be relied upon to eliminate the risk of injury to the brain.
While participation in the martial arts is very safe, it can never be made risk-free. Proper gear and supervision are essential, but caution and control will always be the best tools for self-preservation. ...
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