Concussion (sports-related head injury)
A concussion is a change in the way the brain works due to an injury. The symptoms of a concussion can be subtle. A concussion can occur without an athlete losing consciousness (passing out).
How it occurs
During activity or sports the head of the participant is hit with a projectile (ball), moving object (baseball bat, hockey stick, golf club, etc.), another player, contact with a stationary object (goalpost, fence) or the ground. There are other causes of concussions outside of activity and sports; for example, car accidents and unexpected falls.
Signs and symptoms
There are many observable signs and symptoms that may help identify a concussion. See the lists below:
Observable signs (changes a parent or coach might notice)
- Loss of consciousness
- Vomiting
- Vacant stare/glassy-eyed gaze
- Poor coordination/balance
- Impact seizure
- Slow to answer questions or follow directions
- Slurred speech
- Poor concentration
- Personality changes
- Inappropriate emotions
- Inappropriate playing behavior
- Decreased playing ability
- Confusion/disorientation
- Amnesia: Retrograde – the inability to recall events before the injury; Anterograde – the inability to form new memories after the injury
Symptoms (changes an athlete with a concussion might describe)
- Headache (most common symptom)
- Pressure in the head
- Balance problems
- Dizziness
- Nausea
- Feeling “dinged,” “foggy,” stunned or “dazed”
- Visual disturbance (seeing stars or flashing lights, double vision)
- Sensitivity to light
- Sensitivity to noise
- Hearing problems
- Tinnitus (ringing in the ears)
- Irritability
- Weakness and/or numbness anywhere in the body
- Emotional changes
- Fatigue, feeling sleepy or “slowed down”
- Sleep disturbance (sleeping more or less than usual)
If any of these observable signs and/or symptoms is noticed following a blow to the head, the athlete should have an evaluation by an athletic trainer or physician. These providers can examine the athlete and recommend a treatment such as sitting out the remainder of the competition or activity, visiting an emergency department or following-up with a primary care doctor or sports medicine doctor. Athletes should not be allowed to return to play until they have been cleared to return by a physician. An athlete should not be left alone for the first few hours following a concussion; he or she should be accompanied by an adult who can monitor for signs of worsening symptoms. If a parent or coach notices an athlete has progressively worsening symptoms following a head injury, he or she should arrange to have that athlete evaluated in the emergency room right away.
Diagnosis
A physician will take a careful history and perform a physical exam. The exam includes questions and tasks that test memory, balance, reaction time and attention; your physician may also have you perform a computerized exam that tests these abilities. The physician may refer athletes to a neurologist or neuropsychologist if symptoms are prolonged or there are particular findings on the physical exam.
Physicians use scans of the brain such as a computed tomography (CT) or magnetic resonance imaging (MRI) for some patients to evaluate for the presence of other conditions. Not everyone with a concussion or head injury needs a scan of the brain, and patients with concussions usually have normal scans. The physician will determine if a scan needs to be done based on the patient's injury, observable signs and symptoms.
Treatment
The brain needs rest after a concussion. The physician may call for a period of rest from activities that require a lot of mental strain and concentration. He or she may recommend delaying school projects and tests, avoiding or even taking time off school. Decreasing or eliminating ‘screen time' (video games, television, computers, text messaging) can also help rest the brain. All sports activities should be avoided, not just those with a risk of head injury. Athletes should not perform any activities which raise the heart rate (for example organized sports, running, biking, dancing) until their physician gives them the go-ahead. Once the signs and symptoms have resolved the physician will develop a protocol for returning slowly to activities.
It is important to understand that recovery from a concussion is different for each individual. There is no standard protocol for recovery and the severity of the concussion is never known until normal mental status and physical abilities return to pre-concussion levels.
Returning to activity and sports
Returning to activity and sports too early puts the athlete at risk for prolonged symptoms and more serious brain injury. Your physician will develop a schedule for how you should progress back to activities safely once all the symptoms have resolved. Below is an example of a schedule for return to activities:
-
Day 1: Light jogging
-
Day 2: Simple drills with no risk of contact
-
Day 3: Fast running, light resistance/strength training such as push-ups and sit-ups
-
Day 4: Complex drills with no risk of contact, moderate resistance training
-
Day 5: Full practice, higher resistance training
-
Day 6: Games
If symptoms return with progression of activity, stop activities and return to the previous step the next day.
Preventing concussions
People that have had one concussion are at higher risk for another concussion in the future. To prevent concussions and head injuries it is important to:
- Wear the proper safety equipment for the sport
- Be aware of the rules and avoid positions or plays that put your head or neck in danger (like spearing in football and improper heading technique in soccer)
- Consider lower-impact activities and sports if repeated concussions are becoming problematic
For more information on concussions visit: