Lacrosse Injuries: “Post Concussion Syndrome” Should Be Monitored Closely

Dr. Larry W. McDaniel and Matt Ihler discuss present information related to the individual effects of concussions and how concussion syndrome may be prevented.

The purpose of this paper is to inform coaches, athletes, and other individuals about the prevention and care of concussions. This paper will discuss concussion syndrome and the effects of concussions on individuals. Concussions are a serious injury and should not be overlooked under any circumstance. There are numerous steps that can be taken to help prevent concussions and care for them.

 Sports related concussions are a common injury that can happen to any athlete in any sport. There is an estimated 300,000 sports related traumatic brain injuries, mostly concussions, occur annually in the United States (2). Concussions should be taken seriously and monitored closely. Concussions are the most common type of acute brain injury in sports (5).

The presence of post-concussion symptoms when making return-to-play decisions may expose athletes to subsequent injury if complete recovery has not occurred. Athletes, coaches, and athletic trainers must be educated in the processes of preventing and treating concussions. Developing an effective sport-related concussion preventive measure depends upon increasing our knowledge of concussion rates, patterns, and risk factors (2). Concussions in sports have been increasing over the past several years. As the number of athletes who participate in sports increase, the number of concussions increases. Repetitive concussions and post-concussion syndrome have been responsible for the retirement of many high profile athletes. The athlete’s physical and mental status may be affected by the development of a serious brain injury.

The most common symptoms of post-concussion syndrome include headache, dizziness, blurred vision, neck pain, fatigue, problems sleeping, and problems with balance or coordination. An athlete suffering from a concussion should be monitored for at least 24 hours following the concussion. In addition to monitoring, the athlete should be awakened during sleep every 2 hours (3). On average, certified athletic trainers care for seven to eight concussions per year. Not only should athletic trainers be able to recognize the obvious signs of a concussion, but they should be aware of the self reported symptoms as well. Athletic trainers need to be informed that no two concussions are the same and that the symptoms may be different from one concussion to the next.

The primary mechanism of a concussion involves contact with another person (2). As Harmon states, there are many potential risks for athletes who return to activity too early. This includes the possibility of permanent neurological impairment from cumulative trauma, post-concussion syndrome, and the most severe of all, death resulting from a second brain impact syndrome (Harmon). Athletes who suffer from second-impact syndrome remain alert for several seconds prior to collapsing. After suffering a concussion, the chances that the athlete may sustain another concussion increases by four to six times (4).

Concussions are a clinical syndrome characterized by immediate, transient post-traumatic impairment of neural function caused by changes in consciousness, disturbance of vision, or equilibrium. The loss of consciousness (LOC) does not correlate directly with the severity, or outcome of a concussion (6). Concussions represented approximately 8.9 percent of all high school athletic injuries and 5.8 of all collegiate athletic injuries (2). The rates at which concussions occur are higher among college athletes than high school athletes. College athletes are bigger, stronger, and more aggressive than high school athletes. In addition, concussions represent a higher proportion of all injuries sustained by high school athletes. Females were found to have a higher rate of concussions than males (2). Most concussions were reported while playing soccer, lacrosse, and American football (1).

The symptoms most frequently associated with a concussion include headache, dizziness, and confusion. Research in the area of sports-related concussions has provided athletic training and medical professions with valuable new knowledge. Concussion injury rate was 0.23 concussions per 1000. The rates of concussions were higher during competition as compared to practice rates. The practice rate was 0.11 concussions per 1000 while competition rates rose to 0.53 per 1000(2).

An athlete who loses consciousness or experiences amnesia longer than 15 minutes should immediately be referred to a physician for further evaluation. The athletic trainer should take a conservative approach when dealing with an athlete who has suffered a previous concussion (3). The education and knowledge of coaches, athletes, and parents play a vital role in preventing and treating concussions in the future.

Documenting the information pertaining to the specific injury is an important task for the training staff. This process includes the time and date of the injury, state of consciousness, initial signs and symptoms, and findings during testing (3). The recognition of a sports-related concussion may be extremely difficult, therefore, numerous concussions are overlooked and not treated. Many athletes may have no obvious signs that indicate they have suffered a concussion.

The signs and symptoms associated with a concussion may disappear rapidly, or remain present for an extended period of time. A concussion may cause an immediate and short-lived impairment of neurologic function. Compressive, tensile, and shearing are three types of stresses that are generated by an applied force that injure brain cells (3). It is important for the athletic trainer to assess the cranial nerves, coordination, and motor functioning following a suspected concussion (4). When evaluating a concussion, the athletic trainer should ask the athlete a number of questions involving orientation verses recent memory. Orientation questions are concerned with time and place.

Sample questions trainers may use for assessing an athlete’s memory include; “which field were you playing on”, “what is the name of the team we are playing”, “which quarter, period, or half is it”, “which team scored last”,”what team did we play last week”, or “did we win”. The Balance Error System may be used as a screening tool to determine return-to-play readiness. Athletes are asked to close their eyes and hold their hands at their hips. The trainer will have the injured athlete perform this test on different surfaces. The presence of any stumbling, opening of the eyes, or lifting hands indicated a possible concussion (6). The athlete’s airway, breathing, and circulations should be a priority for evaluation by the trainer.

Following these procedures, the trainer will determine whether or not the athlete loses consciousness, evaluate recently acquired memory, evaluate postural stability, and symptoms (4). An athlete who has sustained a concussion should be evaluated at rest as well as during exertion. Symptoms may not be present at rest, but will return throughout the duration of physical exertion.

A scale from one to three will be used to determine the seriousness of the concussion. A grade one concussion will involve transient confusion, no loss of consciousness, a short period of post-traumatic amnesia, and symptoms lasting longer than 15 minutes. A grade two concussion will include loss of consciousness for less than 5 minutes and amnesia that may last 30 minutes. A grade three concussion will involve a loss of consciousness (LOC) for more than 5 minutes and extended amnesia (1). The trainer will search for any indications of dizziness, headache, and inability to concentrate. The athletic trainer should not allow the athlete to return to play in any circumstances while symptoms are present. Current guidelines suggest that athletes who experience loss of consciousness (LOC) should not return to play on the day of the injury (6). The length and duration of the symptoms along with LOC will be important when determining the severity of the concussion. According to Harmon, more than 90 percent of all concussions are mild and less than 10 percent result in the athlete losing consciousness (Harmon).


  1. Covassin, T., Swanik, C. B., & Sachs, M. L. (2003). Sex Differences and The Incidence of Concussions Among Collegiate Athletes. Journal of Athletic Training, 38. Retrieved April 1, 2008, from Proquest database.
  2. Gessel, L. M., Fields, S. K., Collins, C. L., Dick, R. W., & Comstock, R. D. (2007). Concussions among United States High School and Collegiate Athletes. Journal of Athletic Training, 42, 9. Retrieved February 15, 2008, from Proquest database.
  3. Guskiewicz, K. M., Bruce, S. L., Cantu, R. C., & Ferrara, M. S. (2004). National Athletic Trainers Association Position Statement: Management of Sports Related Concussion. Journal of Athletic Training, 39, 18. Retrieved February 15, 2008, from Proquest database.
  4. Harmon, K. G. (1999). Assessment and Management of Concussion in Sports. American Family Physician, 60, 4. Retrieved March 20, 2008, from EBSCOHost database.
  5. Powell, J. W. (2001). Cerebral Concussion: Causes, Effects, and Risks in Sports. Journal of Athletic Training, 36, 5. Retrieved April 1, 2008, from Proquest database.
  6. Whiteside, J. W. (2006). Management of Head and Neck Injuries by the Sideline Physician. American Family Physician, 74, 6. Retrieved March 20, 2008, from EBSCOHost database.

About the Authors

Dr. Larry McDaniel is an associate professor and advisor for the Exercise Science program at Dakota State University, Madison SD USA. He is a former All – American in football and Hall of Fame athlete & coach. Matt Ihler is a student enrolled in Exercise Science at Dakota State University.

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