Concussion Symptoms, Diagnosis & Treatment | Scottish Rite for Children

Sport-Related Concussions

A concussion is a brain injury that disrupts normal brain function. The usual cause is a sudden blow to the head or body that shakes the brain, damages cells and creates chemical changes. Concussions are quite common. Most athletes who suffer a sports-related concussion do not lose consciousness or experience memory loss.

Full recovery from a concussion before returning to sports can reduce the recovery time. Studies have also shown that returning to play too soon can leave an athlete at a higher risk of another concussion or other bone and joint injuries.

Learn how to recognize and respond to signs and symptoms of a concussion below and download this sport-related concussion guide to reference later.

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Read articles about sport-related concussions on our blog.

Learn More About Concussions

Recognition

How do you know if you have a concussion?
As many as 40% of young athletes continue to play in a game or practice after sustaining a concussion. Some report this is because they were not experiencing symptoms at the time and did not recognize they were injured. Others chose to continue to play because they were not fully aware of the risks, including a longer recovery time. Therefore, observing an athlete for signs and symptoms of a concussion during practice or games is very important. Players, coaches and parents should speak up and remove the athlete from play when a concussion is suspected.

Some signs and symptoms following a head injury that are especially concerning. Seek medical attention immediately at the nearest emergency department if any of the following occur:

Severe or worsening headache
Increasing confusion
Extreme sleepiness or trouble waking up
Vomiting
Seizures (convulsions - arms and legs jerk uncontrollably)
Weak or numb arms or legs
Slurred speech
Any other sudden change in thinking or behavior

WHAT ARE SIGNS OF A CONCUSSION?
WHAT ARE SYMPTOMS OF A CONCUSSION?

Signs of a concussion are observed by others and include:

Appearing dazed or stunned
Confusion
Forgetting plays
Being unsure of game, score or opponent
Exhibiting unsteadiness
Moving clumsily
Answering questions slowly
Losing consciousness (getting knocked out)
Memory loss
Being more sleepy or tired than usual
Seeming sad, nervous or anxious
Being irritable, easily frustrated or upset
Having problems with academic performance
Slow to get up after a fall, collision or blow to the head
Clutching the head after an injury
Sleep problems

Concussion symptoms are felt by the athletes and include:

Headaches
Concentration or memory problems
Nausea
Balance problems or dizziness
Double or blurred vision
Feelings of being “in a fog” or slowed down
Sensitivity to light or noise
Confusion
Just “not feeling right” or “feeling down”

Responding

How is a Concussion Diagnosed and Treated?

There is not a specific test to diagnose a concussion. If there is concern for other problems like a skull fracture or bleeding in the brain, an imaging study, such as a CT scan, may be ordered. These are usually not required and do not show if an athlete has had a concussion. A history and physical examination, along with the patient and family’s report of signs and symptoms, along with tests to assess balance, eye movements, memory, reaction time, etc., are utilized to diagnose a concussion and determine the best treatment for the athlete.

Concussion treatment plans are individualized based on the signs and symptoms experienced by the athlete, as well as results of testing performed during the evaluation. Every injury is different, so there is not a single treatment approach that is best for every patient.

Sport-related concussion treatment options may include:

Activity modification to limit exacerbation of symptoms. Release to begin progression back to activity should not be delayed longer than necessary.
Home program or physical therapy to address symptoms such as neck pain, vestibular changes and balance problems.
Medications may be prescribed to help with sleep disturbances or other symptoms.
Sports neurology referral for headaches or other neurological symptoms.

We find that young athletes take longer to recover after treatment, even if they are following recommendations. For some, symptoms may last for months. Our goal with concussion treatment and management is to get an athlete back to school and daily function as efficiently as possible. Then, we begin return to sport protocols.

COMPUTERIZED NEUROCOGNITIVE TESTING

This is a collection of computerized tests used to to assess the cognitive function of the athlete’s brain when evaluating for a sport-related concussion. Our team uses ImPACT™, an online, neurocognitive test which measures the ability to perform certain tasks, such as memory and reaction time.

If a baseline test is available, our trained staff including several Credentialed ImPACT™ Consultants (CIC) can analyze the results. The comparison of the post-injury scores to the baseline test helps the provider develop an individualized plan for the athlete.

Baseline Testing Appointments

Athletes 5 years of age and older without a recent history of a head injury can take a baseline test, used for future reference (ages 5-12 will be given ImPACT^TMPediatric). For athletes with a recent head injury, we recommend making an appointment with one of our sports medicine physicians before scheduling a baseline test. Call 469-515-7100 to schedule an appointment for an injury assessment or baseline testing.

Baseline testing is not covered by most insurance plans. A $24 credit card payment is required at check-in. Before starting the test, our staff will ask a few questions about the athlete’s history; however, there will be no physical examination or discussion with a physician. If necessary, only one caregiver may remain in the room with the athlete during the test to allow the athlete to concentrate and for optimal test performance. Testing lasts approximately 45 minutes.

Results are provided upon request. Call 469-515-7100 to request a unique code (Passport ID) for another Credentialed ImPACT™ Consultant to access the results.

SIGNS

Signs of a concussion are observed by others and include:

Appearing dazed or stunned
Confusion
Forgetting plays
Being unsure of game, score or opponent
Exhibiting unsteadiness
Moving clumsily
Answering questions slowly
Losing consciousness (getting knocked out)
Memory loss
Being more sleepy or tired than usual
Seeming sad, nervous or anxious
Being irritable, easily frustrated or upset
Having problems with academic performance
Slow to get up after a fall, collision or blow to the head
Clutching the head after an injury
Sleep problems

SYMPTOMS

Signs of a concussion are observed by others and include:

Appearing dazed or stunned
Confusion
Forgetting plays
Being unsure of game, score or opponent
Exhibiting unsteadiness
Moving clumsily
Answering questions slowly
Losing consciousness (getting knocked out)
Memory loss
Being more sleepy or tired than usual
Seeming sad, nervous or anxious
Being irritable, easily frustrated or upset
Having problems with academic performance
Slow to get up after a fall, collision or blow to the head
Clutching the head after an injury
Sleep problems

Return to Play Decision-Making

How long will a concussion last?
Concussion protocols are typically designed as a one week return to play progression. This is often misinterpreted as the answer to “how long does a a concussion last?” The protocol insists that the five- to seven-day progression begins and only continues when the athlete is symptom free. In college athletes and adults, a week or two is typical. We find that young athletes take longer to recover, even if they are following recommendations. For some, symptoms may last for months. Our goal with treatment and management of concussions is to get an athlete back to school and daily function as efficiently as possible. Then, we begin return to play protocols.

RETURN TO SCHOOL
RETURN TO PLAY

If available, a school nurse or athletic trainer should be involved early to help the family with the safe return to school and sports as they often have additional training in the management of concussion and may consider these accommodations for a student athlete:

Reduce homework and class work.
Postpone tests until the student has recovered.
Provide alternative activities for the athlete for taking notes during class, watching videos, being in a loud environment (lunchroom or gymnasium), or participating in physical activity (PE, athletics, recess).
Allow frequent breaks in the nurse’s office or alternating a class with a rest.
Facilitate visit to the nurse’s office for worsening of symptoms during classes.

Clearance by a health professional is strongly recommended, and, in some cases, required by law, the school or an organizational concussion protocol. Returning to play before complete recovery from a concussion puts the athlete at risk for a more serious injury, permanent brain damage and even death, from another injury known as Second Impact Syndrome.
When the athlete has returned to everyday and school-related activities and has no symptoms, make an appointment for an evaluation and sports clearance. For patients with severe or persistent symptoms, a referral to a sports medicine specialist may be helpful.

Return to Play Guidelines:
Once the athlete is completely symptom-free, and has been cleared by a health care professional, they may begin a progressive return-to-play protocol. A symptom-free period of 24 hours is required before moving on to the next stage. If symptoms occur during or after activity, the athlete should stop and consult with their health care provider.
Remember, the athlete MUST BE symptom free:

with daily activities and schoolwork (including tests) to begin the protocol.
during/after exercise to progress to next stage.

Return to Sports Progression:

Begin light aerobic exercise with no resistance – e.g. riding a stationary bike or light jogging for 10-15 minutes.
Sport-specific activity – e.g. running drill for 20-30 minutes with increased exertion.
Non-contact training drills with resistance training – e.g. ball handling or passing drills
Full contact practice (must have physician clearance) – e.g. scrimmage and game-like training drills.
Competitive game play.

How is Scottish Rite helping improve concussion management and prevention?

Following the rules is the best way to prevent a concussion. Some studies show that wearing appropriate protective gear, and improved core and neck strength may contribute to a lower risk of injury. Though we do not have strong evidence of how to prevent a concussion, we are confident that recognizing a concussion immediately and responding appropriately will reduce the risk of further injury and decrease concussion recovery time.
Research on sport-related concussion at Scottish Rite is helping with understanding what makes symptoms last longer for some than others.

Concussion symptoms are worse and last longer when an athlete continues to play on the same day as their injury
Girl soccer players are more likely to continue to play on the same day, but boys do too
Poor sleep is connected to worse concussion symptoms and longer concussion recovery time.
Anxiety symptoms following a sport-related concussion lead to more time before returning to play.
In female athletes, delayed presentation to clinic is associated with longer time to clearance to return to play following a sport-related concussion, so it is important to be evaluated soon after the injury.

Learn more on the Sports Medicine Research page.

Bridge Program and Training Classes

Young athletes cleared from therapy but not quite ready to get back to sport should check out our Bridge Program. Get ready to return safely to sports with our team of strength and conditioning coaches in Frisco. Additionally, our coaches offer a variety of performance courses to help improve muscle strength and movement quality and help prevent future injuries.

Learn more here: What is the Bridge Program?