A concussion is any injury to the brain that disrupts normal brain function.  Concussions are typically caused by a direct or indirect blow or jolt to the head.

All concussions are serious, and all athletes with suspected concussions should not return to play until they see a doctor.

When do concussions occur?

Concussions can happen in any sport but more often occur in collision sports, such as football, rugby, lacrosse or ice hockey.

They also are common in contact sports that don’t require helmets, such as soccer, basketball, and wrestling.  Concussions can also occur from a collision with the ground, a wall, or post (cheerleading, tumbling, gymnastics, or horseback riding); or a ball that has been thrown, hit, or kicked.

Many pediatric concussions also occur outside organized sports. For example, a child riding a bike or skateboard can fall down and bump his head on the street or an obstacle.

Symptoms

The hallmark symptoms of concussion are confusion and memory loss (in particular amnesia of the event or play that caused the injury). The symptoms of a concussion range from subtle to obvious and usually happen right after the injury but may take hours to days to show up. Athletes who have had concussions may report “feeling normal” before their brain has fully recovered. With most concussions, patients are not knocked out or unconscious, but loss of consciousness can occur in up to 10% of concussions.

Symptoms of a concussion include the following:

  • Headache*
  • Nausea or vomiting*
  • Dizziness or balance problems*
  • Lack of awareness of surroundings*
  • Trouble remembering
  • Confused or forgetful about recent events
  • Loss of consciousness (<10%)
  • Double or blurry vision
  • Sensitivity to light
  • Sensitivity to noise
  • Feeling dazed or stunned
  • Feeling mentally “foggy”
  • Trouble concentrating
  • Slow to answer questions
  • Changes in mood—irritable, sad, emotional, nervous
  • Drowsiness
  • Sleeping more or less than usual
  • Trouble falling asleep

*Early concussion symptoms usually apparent within minutes to hours.

PAY SPECIAL ATTENTION TO THESE SYMPTOMS:

In the first 24-48 hours, all patients with concussions should be observed carefully for sudden onset of any “red flag” symptoms.  Any positive report requires urgent emergency medical evaluation since these symptoms may represent deteriorating neurological function:

  • Headaches that worsen
  • Can’t recognize people or places
  • Looks very drowsy/cannot be awakened
  • Repeated vomiting (2 or more)
  • Slurred speech
  • Increased confusion or irritability
  • Weakness/numbness in arms/legs
  • Unusual behavior changes
  • Neck pain
  • Any other focal neurological sign

Diagnosis

Prematurely returning to play after a concussion can lead to another concussion or even death.  Therefore, the quality of the sideline symptom assessment is crucial in order to prevent a catastrophic event.  The Standardized Assessment of Concussion (SAC) (www.tinyurl.com/c9ahcl6) was developed as a tool for the sideline evaluation of athletes with a suspected concussion. The SAC should not be used to determine readiness for return to play (RTP) and is probably most useful in the acute injury setting when a baseline measure has already been done.

A doctor can confirm the diagnosis of concussion; determine the need for any specialized tests, such as CT scan, MRI, or neuropsychological tests; and decide if and when it is OK for the athlete to return to play.

An athlete with a history of concussion may be more susceptible to another injury than an athlete with no history of concussion.

No one knows how many concussions are too many before permanent damage occurs. Repeated concussions are particularly worrisome, especially if each one takes longer to resolve or if a repeat concussion occurs from a light blow. Notify your doctor of any prior concussions.

Treatment

Recovery time from concussion is variable based on the individual, the severity of the concussion, and the history of prior concussions.

Pediatric and adolescent athletes should never be returned to play the same day of injury.

Do not rush through the return protocols.

Prevention

Not all concussions can be prevented, but some may be avoided. Helmets should be worn for any riding activities (like horseback, all terrain vehicle (ATV), motorbike, bike, skateboard, or

snowboard) or contact sports (like football, hockey, or lacrosse). Helmets should fit appropriately and be in good condition (www.usafootball.com/health-safety/helmet-safety-starts-proper-fit). Athletes should be taught safe playing techniques and to follow the rules of the game.

 **Most importantly, every athlete needs to know how crucial it is to let their coach, athletic trainer, or parent know if they have hit their head or have symptoms of a head injury—even if it means stopping play. Never ignore a head injury, no matter how minor.

RETURNING TO LEARN

Patient Instructions

Plan: Please read ALL these instructions.

  • REST – NO athletic or play activity, NO exercise, for now. Only essential walking
  • SCHOOL ATTENDANCE – we strongly encourage you to attend school every day. Most students are able to go to school all or part of the day while they are recovering from their concussion. We recommend the following modifications to your school day:
    • Please allow the student to take breaks during tests
    • Athlete should NOT be required to attend team functions (practice, meetings should be optional)
    • We can request other school modifications as needed
  • COGNITIVE REST (“brain rest”)
    • Only essential texting and phone calls (e.g. “come pick me up at school”)
    • Minimal TV watching (2 hrs/day)
    • May use computer for homework
    • Limit use of social media to 15 minutes per day
    • No gaming or web surfing
    • No loud music
  • SLEEP – minimum 8 hours per night, bedtime no later than 10 pm
    • Stick to a regular bedtime schedule, even on weekends
    • No caffeine (sodas, coffee, tea, energy drinks, chocolate)
    • Stop using your cell phone, computer, tablet or TV 30 minutes before bedtime
    • If you must nap during the day, keep the naps < 30 minutes
  • MEDICINE – Use ibuprofen for headache pain; take every 8 hours, for pain > 4/10
  • NUTRITION – Do not skip meals and drink plenty of fluids
  • Call our office if you have ANY questions or concerns

RETURNING TO PLAY 

When returning athletes to play, they should follow a stepwise symptom-limited program, with stages of progression. For example:

  1. Rest until asymptomatic (physical and mental rest)
  2. Light aerobic exercise (e.g. stationary cycle)
  3. Sport-specific exercise
  4. Non-contact training drills (start light resistance training)
  5. Full contact training after medical clearance
  6. Return to competition (game play)

There should be approximately 24 hours (or longer) for each stage and the athlete should return to stage 1 if symptoms recur. Patients who follow an appropriately-paced RTP are usually symptom-free within 7 to 10 days.

Download PDF
SCAT 3 Concussion Survey (PDF)