Concussion, also known as mild traumatic brain injury (mTBI) or mild head injury, is defined as a traumatically induced transient disturbance of brain function caused by complex pathophysiologic processes according to the American Medical Society for Sports Medicine position statement. These processes may include oxidative stress, impaired axonal transport, and altered neurotransmission. Centers for Disease Control and Prevention (CDC) guidelines criteria for concussion include confusion or disorientation, loss of consciousness for 30 minutes or less, post-traumatic amnesia for less than 24 hours or other transient neurologic abnormalities, and Glasgow Coma Scale (GCS) score 13-15 at least 30 minutes after injury. Concussion in sport is currently estimated at about 3.8 million per year in the United States and continues to rise at about an annual rate of 7% per year. Specifically related to gymnastics, a study of children ages 6-17 treated at US hospital emergency departments indicated that concussion/closed head injuries comprised 1.7% of all gymnastics-related injuries. In addition, the frequency of these injuries decreased with increasing age. According to a recent review, concussion comprised 3% of Olympic injuries and up to 8% of all injuries across pooled studies of gymnastics injuries. When looking at NCAA surveillance data from 1988 through 2004, concussions were 2.3% of all injuries in women's gymnastics with a 0.16 injury rate per 1000 athlete exposures. However, self-reported history of concussion symptoms may be up to 15.6-30.2%, possibly suggesting a majority of these are unrecognized and do not present for clinical care.
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