As of 2010 and according to the Centers for Disease Control and Prevention there may be as many as 3.8 million sports and recreation related concussions in the United States every year. Concussions account for 10% of all sports injuries, and for young people ages 15-24 sports are second only to motor vehicle accidents as the leading cause of brain injury. United States emergency departments treat an estimated 135,000 sports and recreation traumatic brain injuries (TBI), including concussions, each year in children ages 5 to 18. It is pretty evident that concussions can happen in any sport, at any age. Conventional wisdom tells us that Baseball is considered a skill sport, not a contact sport. So how can a baseball player end up with a concussion? There are multiple ways.

    1. Batter hit by a pitch
    2. Collisions on the bases between a fielder and a base runner. It happens more than you think.
    3. Collisions in the field between fielders on the same team.
    4. Pitcher gets hit in the head by a batted ball.
    5. Collisions at home plate between a base runner and the catcher.
    6. Foul tips off the catcher’s mask. A freak play is when the batter swings and misses and the bat hits the catcher on the head on the back swing.

The first bullet point is why you use batting helmets with an earflap. Getting hit in the head by a thrown baseball, without protection is dangerous, even in Little League. Despite the time taken between pitches Baseball can be a very fast moving game, typified by sudden bursts of action. A base runner slides into second or third and can get kicked or kneed in the head when a fielder goes for the ball or attempts to apply a tag. Fielders can, and have run into each other going for a ball. One fielder doesn’t hear the other calling for the ball or neither call for the ball. In an era where almost all non-professional leagues use aluminum or carbon fiber bats there is a danger of a batted ball coming back to a pitcher and hitting them in the head, especially their face. There have been multiple incidents where  high school, college and even Little League pitchers have sustained very serious injuries from batted balls. In one tragic incident an 8th grader in Vermont died from getting hit by a batted ball. Before the 2014 season MLB issued new rules concerning home plate collisions. The purpose behind the rules is to minimize the possibility of the catcher getting nailed in a home plate collision and ending up getting injured and / or sustaining a concussion. Hopefully, other leagues follow suit. However we believe that the real danger for catchers is the foul tip. In many cases catchers have gone to hockey style helmets or masks with titanium cages instead of the old, heavy iron bars and that might be a mistake. There is no real statistical evidence supporting that point but it is pretty evident that masks with lighter, thinner cages do not appear to protect the catcher as well as the old style iron bar masks. It appears that the iron bars do a better job of absorbing the impact of a batted ball. In any case we believe more research needs to be done on this issue. What is a Concussion? A concussion is a brain injury that can be caused by a blow or jolt to the head and can change the way the brain normally works. Any and all concussions are serious and should be treated that way. Does not matter whether they are very mild or very serious. A concussion can also be caused by a blow to the body that causes the head to move rapidly back and forth and causes the brain to strike the surrounding skull. Most of the time concussions do not result in a loss of consciousness. In fact, that only occurs 10% of the time. Some of the symptoms of concussion that may be reported by the athlete are as follows: Headache, Nausea, Dizziness, Sensitivity to Light, Memory Problems, Confusion, Sensitivity to Noise, Slowed Reaction Times, Drowsiness, Loss of Balance, Vomiting and Blurred Vision. Coaches may observe the following in a concussed athlete:

  • Confusion
  • Dazed
  • Loss of Consciousness
  • Changes to Behavior
  • Clumsy Movement
  • Changes to Personality
  • Cannot Recall Events After Hit or Fall

The following is from the USA Baseball Medical/Safety Committee; “According to the Consensus Statement on Concussion in Sport by the 3rd International Conference on Concussion in Sport, an athlete showing any of the above signs of concussion should be medically evaluated onsite. If no health care provider is available, the player should be removed from play and referred immediately to a physician. Once the first aid issues are addressed, an assessment of the concussion can be made. The player should not be left alone following the injury because monitoring for deterioration is important. A player with a diagnosed or suspected concussion should not be allowed to return to play on the day of the injury. Concussed athletes should not return to play until all signs and symptoms have resolved at rest, and then following exertion using a graduated protocol (see below). An athlete should never be released to participation without a signed statement from a medical physician. There should be a graduated return-to-play protocol following a concussion, and the athlete can proceed to the next level if there are no symptoms at the present level. The graduated return-to-play protocol is as follows: (2) Each step generally takes 24 hours. If there are any symptoms at any stage, the athlete should drop back to the previous stage.

  • No Activity — Complete physical and cognitive rest
  • Light aerobic exercise — Walking, stationary bike, no resistance training
  • Sport-specific exercise — Running drills, etc, no head impact activities
  • Non-contact drills — Start progressive resistance training
  • Full contact practice — Following medical clearance normal training activities
  • Return to play — Normal game play

A repeat concussion before the brain fully heals can slow recovery and increase the possibility of long term problems. In some cases repeat concussions can result in permanent brain damage and death, which is called second impact syndrome. It is important for athletes, coaches, and parents to be aware of the signs and symptoms of concussion, how to prevent concussions, and to never to allow an athlete to return to play following a concussion without proper care- no matter how minor the injury might seem. Every organization should have a written injury management protocol, and everyone associated with the organization should have a copy – coaches, athletes, athletic trainers, physicians, and parents.” The bottom line here is very simple. If a player exhibits any sign of concussion the player must leave the game immediately and get medical attention from a qualified medical professional. Coaches, we all know that your best athletes will argue that they are fine and feel OK. Ignore their arguments and take ownership of the situation. Again, immediately remove the player from the game and get them to a Physician. The player’s health comes first, everything else is in last place. Parents, if a coach has left a player with concussion symptoms in the game you need to get your child to a Physician immediately. After that you need to have a very serious conversation with the people that coach reports to about his/her irresponsible behavior. A concussion is not like a bruised knee, the effects can linger and create problems later in life.

USA Baseball created an outstanding infographic for Concussions in Baseball. Please click the “Infographic” tab at the top of the page. After you look at the infographic please return to the top of the page and click the “Video” tab to watch the outstanding video produced by CNS Maryland on Concussions in Baseball.

The following Infographic was created by USA Baseball.

USA-Baseball-Concussion-Clipboard-Infographic-600px

Please return to the top of the page and click the “Video” tab to watch CNS Maryland’s outstanding video on Concussions in Baseball, Catching Trouble – Concussions in Baseball.

Catching Trouble – Concussions in Baseball