Recently, concussions have received greater community attention secondary to spotlighted concussed athletes in the NFL, NHL, and even NASCAR. Understanding concussions and how to best treat them has changed with research and medical advancement. Gone is the belief that a person with a concussion needs to be woken up hourly throughout the night. Also, it’s now understood that concussions are much more serious than the old belief of just “having their bell rung.” Concussions need to be respected. Otherwise, athletes risk prolonged medical issues and even death. In this article, we will discuss what a concussion is, how to recognize it, and how both athletes and their parents/caregivers can assist in the recovery process.

The medical definition of a concussion is that it’s a “complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces.” Huh?! What medical professionals are saying is that a traumatic force interferes with the brain’s normal function. This force can be caused by a direct blow to the head, face or neck; or by indirect impact. Indirect impact includes landing hard on your feet where the force travels up to the brain. Athletes who play contact/collision sports (E.g. football, ice hockey, soccer) have a higher risk of sustaining a concussion. Signs and symptoms of concussions usually occur rapidly and are short in duration.

Signs and symptoms of a concussion include the following-loss of consciousness, headache, feeling “foggy”, depression, unusually “emotional,” amnesia, irritability, light and/or noise sensitivity, slowed reaction time, drowsiness, decreased balance, etc. An athlete with a concussion may not experience unconsciousness. Therefore, their other symptoms need to be taken into consideration. Some symptoms may not show up immediately; especially in young athletes (<18 yrs old). Athletes with a concussion should be monitored for a few hours after the injury occurs. Parents/caregivers should call 911 for the concussed athlete if their headache becomes severe, they start to lose consciousness, experience loss of movement or numbness/tingling in the extremities.

Signs/Symptoms of a Concussion

• Loss of consciousness
• “In a fog”
• Emotional, irritable, depressed
• Drowsy
• Decreased balance
• Slowed reaction times

An important fact to remember is that concussions cannot be seen on X-rays, CT scans, or MRI’s. A concussed athlete will have a normal MRI because there is nothing wrong with the structure of the brain. Rather, the problem its impaired function. Other tools are needed to assess concussions. Some schools and sports clubs administer concussion specific tests during preparticipation screening. These concussion evaluations test mental ability, balance, and tolerance to physical activity. Examples of these tests include ImPACT, SCAT3, and SAC. The preparticipation scores are helpful when comparing preseason scores to the athlete’s current score after sustaining a concussion. However, just because an athlete scores as high as his preseason test does not automatically mean the athlete is fit to play again! Athletes must be symptom-free (at rest and with physical activity) and no longer taking medication for their concussion in order to return to full practice and games.

Recovery from a concussion requires both physical and mental rest until symptoms are absent. The concussed athlete should be allowed to sleep as long as their body requires. It is not unusual for an athlete with a concussion to sleep 12-24 hours. Do not wake them up! During the recovery process, the athlete also needs to refrain from texting, driving, using the computer, playing video games, drinking alcohol, or talking on the phone. They need to rest in a quiet, dark room. Do not give the athlete aspirin or ibuprofen for headaches! Aspirin and ibuprofen increase the risk for bleeding. The athlete may use Tylenol or other brands of acetaminophen instead. During the recovery process, modifications to school activities may need to occur. Examples of modifications include doing school work from home, deferring quizzes and tests until they are recovered, allowing longer time for test taking, doing homework and eating lunch in a quiet room, excused from P.E. class, etc.

Recovery from Concussion

• Uninterrupted sleep in a dark, quiet room
• Tylenol or other acetaminophen only
• No texting, video games, talking on the phone, driving, loud noises or bright lights
• No alcoholic drinks
• Modified school work as needed
• No practice/play for a minimum of 24 hours
• Gradual physical activity that is symptom-free
• Medical care by a qualified medical professional

In most cases (80-90%), concussions resolve in 7-10 days. The recovery time may be longer in athletes younger than 18 years old. Other factors that may prolong recovery time include a history of past concussions, depression, learning disabilities, ADHD, and use of psychoactive drugs or anticoagulants. Athletes younger than 18 years old cannot return to practice/game for a minimum of 24 hours after the injury; and only when symptom-free. Returning too early risks sustaining a second concussion while the athlete is still healing. This condition is called “Second Impact Syndrome;” and can be deadly.

Factors That May Prolong Concussions

• Number of symptoms
• Concussion lasts > 10 days
• Unconsciousness > 1 minute
• Amnesia
• Convulsions
• Time between concussions
• Frequency of concussions
• Age < 18 yrs old
• Less impact needed for concussion
• Slower recovery time with each concussion

Currently, limited resources are available to reduce the risk of concussions. Protective equipment such as helmets and mouth guards do not prevent concussions. On-the-field behavior between players can increase the risk of concussions. 50% of concussions in soccer are due to arm-to-head contact. Some governing bodies in sports such as football, ice hockey, and soccer have made rule changes to penalize these actions, and make the sport safer. Athletes can reduce their risk of concussions by abstaining from overly aggressive behavior.

Concussions, when managed correctly, usually only last a week. It is worthwhile for the athlete to allow the brain to recover completely before returning to the playing field. Trying to play too quickly may result in prolonged symptoms or even death. Coaches and parents/caregivers can do their part by supporting the athlete during their recovery time.

-Heidi Edwards, PT, MPT, OCS, COMT, CSCS