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MUSC Health Blog

Keyword: concussion

By Michael J. Barr, PT, DPT, MSR
Sports Medicine Manager
MUSC Health Sports Medicine

MUSC Health Stadium

Major League Lacrosse is coming to Charleston and MUSC Health Stadium! MLL announced in April that the Charleston Battery will host the 2018 MLL Championship at MUSC Health Stadium on August 18. Luckily, we do not have to wait until August to see Major League Lacrosse in action, as the first-ever MLL game in the state of South Carolina is right around the corner on June 30 at MUSC Health Stadium. This inaugural game is a match between the Charlotte Hounds and the Atlanta Blaze.

The buzz around the Charleston lacrosse community is the excitement about the upcoming matches. Over the past 10 years, lacrosse has been one of the fastest-growing sports in the Lowcountry and throughout the United States. According to USA lacrosse’s 2016 survey, there are over 825,000 players participating in organized lacrosse throughout the country, which is an increase of over 225 percent compared to their first survey completed in 2001.

As the game grows in popularity and participation, the topic of injuries always comes up. Parents are concerned for their children’s well being, as they are with participation in all sports. A study completed by Xiang et al., and published in the American Journal of Sports Medicine in 2014, examined the number of high school lacrosse injuries (male and female) from 2008 to 2012. The top injury type was sprains/strains (38.3 percent) followed by concussions (22.2 percent) and abrasions/contusions (12.2 percent). The majority of the injuries were to the lower extremities (foot/ankle, knee, and thigh). In approximately 40 percent of the injuries that occurred, the players were able to return to play within 1 to 6 days and only 6.6 percent of the total injuries were serious enough to require surgical intervention.

So just like in all sports, injuries can occur in lacrosse, but there are also ways to minimize this risk through injury prevention techniques. Stop Sports Injuries has a full list of injury prevention guidelines for lacrosse players.

To prevent most prevalent injuries, sprains/strains, and concussions, here are my suggestions:


  1. Proper warm-up prior to play: This should include active movement in addition to both dynamic and static stretching.
  2. In season strengthening program: Focus on balance, dynamic stability, and core strengthening.
  3. Offseason training: Fitness training in the offseason can be the most important step to injury prevention. This should include a combination of cardiovascular training, strengthening and flexibility programs, plyometric training, and agility training.


  1. Know the rules and follow the rules: In boys’ lacrosse, when played correctly, unprotected hits should not occur, and in girls’ lacrosse there should be no head/face contact. Unfortunately, rules are not always followed or taught to players, so this is where experienced coaching comes into play.
  2. Wear the proper equipment: Lacrosse equipment is designed to be protective, but if helmets, facial equipment, and mouth guards are worn out or the wrong size, they may not be doing their job, which can lead to increased injuries.
  3. Know the signs and symptoms: If a hit occurs and there is a suspicion of a concussion, players should be held out of play until assessed by a health care professional trained in concussion management. Athletic trainers are your best resource for on-field management. If a concussion does occur, follow return-to-play guidelines to minimize the risk for escalated symptoms or future issues.

In lacrosse, just like in all other sports, there is a risk for injury, but the overall benefits of sports participation significantly outweigh the risks.

If you have read this far, you must be interested in the game, see how the elite do it, and come out to the game on June 30 and all of the festivities surrounding the Major League Lacrosse Championship at MUSC Health Stadium in August.

Guest Post by:
Brittany Darling, MS, ATC
Athletic Trainer
MUSC Sports Medicine

The first week of September - high school football is in full swing, college football has just begun, and the NFL is taking off this weekend. Over the past few years the sport of football has become practically synonymous with the dreaded word “concussion.” The media is in a frenzy about whether it is even safe to play this classic, beloved sport. As an athletic trainer, I hear the term “he just got his bell rung” from coaches, parents, and other players more often than I would like. I hear the arguments exclaiming that, back in the day, all you had to do was be able to declare that you see the two fingers being held up in front of your face, and you’re good to go! With advances in medicine and technology, the medical field is bringing light to the nature and side effects of concussions, and it is not a pretty story. The good news is, there are many steps that can be taken to prevent the occurrence of a concussion.

The most important form of prevention is education. Without knowing how a concussion can occur or what a concussion feels like, it is difficult to know if you, indeed, have a concussion or not. The difficult part is that a concussion is not like a broken bone; you cannot get an x-ray and say definitively yes or no, you have a concussion, like you can with a fracture. Concussion diagnosis is primarily subjective, based upon reports from the patient about how they are feeling or what might have happened. Symptoms include a headache, nausea, dizziness, double vision, sensitivity to light or noise, and feeling off balance. More severe symptoms may include vomiting, memory loss, or loss of consciousness (blacking out). Sometimes this can be difficult for a younger individual to differentiate, but I have found that to err on the side of caution will always produce the best possible outcome. As a coach, parent, or player, if a significant hit to the head is witnessed, either from head to head, head to ground, or even whiplash, then that athlete should be removed from play and evaluated by the athletic trainer or team physician.Football block

Teaching the correct tackling techniques can be extremely helpful in preventing concussions. Many football players, especially those more inexperienced, will put their head down and lead into a tackle with just their head. Some will even purposefully do this, known as a “helmet to helmet” hit. This is incorrect and very dangerous! The head should be up, and the tackle should be made by wrapping arms around the other player. Referees have recently become more aware and have been helping to eradicate this type of tackling. Learning to land when being tackled is also a useful technique to practice, and can prevent many other injuries as well. Always be sure that all equipment, especially the helmet, is fitting appropriately and doing its job to protect you.

Many institutions are now utilizing baseline testing, which performs a cognitive evaluation of the athlete and can be used post-concussion to compare results and ensure that the individual is ready to return to play. This is not used on its own, but in combination with a variety of other diagnostic tools such as the SCAT3, symptom check, and balance error scoring system (BESS). If diagnosed with a concussion, it is important to seek appropriate medical help from a physician, specifically a concussion specialist who has experiencing managing these types of injuries. It is absolutely possible to return to playing football after suffering a concussion, however it is important to follow the return to play protocol provided by your school’s athletic trainer and to be certain of full recovery. With efforts to educate parents, players, and coaches, simple modifications can be applied to make the sport of football safer while still enjoyable.

Guest Post by:
T. Ryan Littlejohn, ATC
Athletic Trainer
MUSC Health Sports Medicine

Have you heard the buzzword concussion in todays sports world? Most people would agree they have heard all the hype about concussions and it is a big deal. There is good reason for this attention to head injuries, they can be serious and need to be managed appropriately. A concussion is an injury to the brain and currently there is no way to completely prevent them from occurring. According to the centers for disease control, there are 3.8 million concussions per year, in the U.S. alone. A concussion occurs when the brain is bruised from hitting the inside of the skull and it can occur from a whip lash or a direct blow to the head. This can lead to concussion symptoms, headache, dizziness, and nausea, which tend to be the most common. If you or someone you know is experiencing problems from a head injury, it is essential that a medical provider trained in concussion management is consulted, before returning to any type of physical activity.

Some research suggests that certain strengthening exercises may help reduce the prevalence or severity of a concussion by reducing or better absorbing the applied force. Specifically, neck strength is something that can be addressed and might help lessen the chance of receiving a concussion. The rationale behind this is simply a stronger neck could help stabilize both the head and neck movement. So take action, implement these simple and easy exercises into your sports program today.

Shoulder Shrugs:

Standing with weight in both of your hands and arms by your side slowly shrug your shoulders upward. Control the weight in both directions - lifting and lowering the weight. Perform for 3x10.

Upright Rows:

Standing with arms in front of you holding a dumbbell or bar, have the palms facing outward. Raise the weight to chest level then slowly lower the weight back to the starting position.  Perform 3x10.

Four Way Isometrics:

Place two hands on back of your head and then push into your hands for isometric resistance. Perform in all four directions - front, back, left and right side of your head. Make sure you feel the resistance in your neck, but keep your head straight.  Perform 1x10 each direction holding for 5 to 10 seconds.

Towel Resistance:

Place a towel behind your head and hold the ends of the towel. Perform resistance against the towel keeping your head straight and pushing backwards. Then change the position and push against the towel going forward. Perform 1x10 reps holding for 5 to 10 seconds.

Resources and Additional Information:

Google search results for concussion

PubMed Abstract on neck strength as a factor in concussion

Mom's Team:  Stronger Necks May Reduce Concussion Risk


Guest Post by:
Avery L Buchholz MD MPH
Resident Physician
Department of Neurosurgery
Medical University of South Carolina

Sports related concussions have become an increasingly important topic. Research has shown a steady increase in the rate of concussions in high school athletes. This along with a better understanding of the injury has added increased importance to the proper management of these athletes. South Carolina has recently passed legislation regarding education and management of concussions. The exact bill passed in South Carolina can be seen using the following link:

In summary, the South Carolina concussion policy states that

1. Local school districts will develop guidelines based on recommendations from the South Carolina Department of Health and Environmental Control.

2. Each year coaches, student athletes, and their parents/guardians will receive information on concussion education and the school must have documented receipt and understanding of this information prior to practice of competition.

3. Any athlete suspected of sustaining a concussion must be removed from play immediately and evaluated prior to returning to play. A player may return to play that same day if the on-site and qualified athletic trainer, physician, physician assistant, or nurse practitioner determines there are no signs of concussion.

4. Players thought to have a concussion will need written medical clearance by a physician prior to returning to play.

As of January 2014, all 50 states have passed concussion laws focusing on various topics including coach training, parent/athlete education, return-to-play (RTP) restrictions, and medical clearance. It is important to recognize that as both players and parents these are now required tasks and having a solid understanding of concussions and proper management will help keep play safe.

Loss of consciousness is not required for the diagnosis of a concussion. In fact most concussions happen without loss of consciousness. Concussions can result from a hit to the head or body resulting in a force causing a disruption of the brain. The most common symptoms of concussion are headaches, nausea, vomiting, dizziness, loss of balance, and blurry vision. Additional symptoms can include emotional changes, irritability, depression, sleep disturbance, poor concentration, sensitivity to light and memory impairment. These later symptoms are often not recognized immediately which is why it is important for players and parents to be properly educated and be able to recognize these symptoms when they occur. If these symptoms are identified it is important to suspect a concussion and seek medical advice. Do not allow continued participation if you suspect a concussion.

Once a concussion is identified it will need to be managed appropriately. Coaches, trainers and team personal should all have undergone training about how to safely get an athlete back into competition after having a concussion. In addition to having medical clearance from a physician prior to resuming athletics an athlete will need to have successfully completed Return to Play Guidelines (RTP). RTP is a graduated return to play strategy consisting of five steps with increased activity in each step. Each step is 24-hrs long and as long as the athlete remains asymptomatic after each step they may advance to the next. If the athlete becomes symptomatic at any point they must stop, rest, and start back at the first step when completely asymptomatic which would be the following day at the earliest. It is also important for athletes to be off all medications which may hide symptoms. The details of allowed activities for each step can be viewed using this link:

Concussions happen and are a part of being active. As players and parents it is important to recognize them when they occur and avoid any activity until the athlete is completely asymptomatic. This can mean both physical and mental rest. Once asymptomatic coaches and trainers will be following return to play guidelines and it is important for you to understand these guidelines as well so you can participate safely.

Guest Post by:
Stephanie Davey, ATC
Certified Athletic Trainer
MUSC Sports Medicine

In the past few years, concussions in sports have been a hot topic. The debate has ranged from how to prevent concussions to how to safely return an athlete to play after a concussion. As it is nearly impossible to prevent head injuries in sports, the focus on returning athletes to play after a concussion is high. We have multiple tools to do this, including cognitive assessment testing.

Cognitive testing evaluates the mental abilities of the brain. After a head injury, an athlete’s cognitive function can be diminished. Functions including but not limited to attention, memory, working memory and processing speed can all be affected by a concussion. In order to properly assess after injury cognitive function, a baseline cognitive assessment should be done on all contact sport and high-risk athletes. The most common way to attain a cognitive baseline assessment is through a computerized test. There are multiple computerized cognitive assessment tests on the market and they all have slightly different methods. However, all the tests should analyze learning and memory skills, ability to pay attention or concentrate, and how quickly the athlete is able to process and solve problems. Ideally, a baseline test should be done every year and prior to practice starting. The environment should be controlled and quiet so the athlete is able to focus while taking the test. Athletes should be well rested, hydrated, and not hungry prior to taking the test. Test results should be kept by the athletic trainer or the doctor administering the test.

concussion imageThere are some concerns with baseline cognitive testing. The most efficient way to test large teams is in a computer lab with multiple athletes testing at the same time. It can be difficult for some athletes to focus in a mass setting, which can lead to a skewed baseline. After injury tests are usually done one athlete at a time and in an office or clinic setting. The change in settings can lead to unreliable results. Athletes also have been known to purposely not try on the baseline, so that their scores will be lower. Lower scores make it easier to pass an after injury tests. Also, computerized baseline testing can be prohibitively expensive for some schools and organizations.

It is important to note that cognitive testing is just one part of the process to safely returning athletes to play. It should not be used as the only criteria to returning an athlete. When used correctly, computerized cognitive assessments are useful tool and should be part the return to play protocol.


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