Concussions

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 (SRC) do not lose consciousness or experience memory loss.

Concussions continue to get a lot of attention in the media, and for good reason. At Scottish Rite for Children, we continue to study young athletes to learn more about how their brains recover from concussions. We already know that concussion recovery time in children is longer than in adults.

Here are a few additional things our patients have taught us:

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.

To learn how to recognize and respond to signs and symptoms of a concussion view our handout (English / Spanish)

Read articles about sport-related concussions on our blog.

Learn More About Concussions

What are the Signs & Symptoms of Concussions?

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 is very important. Everyone should speak up and remove the athlete from play when a concussion is suspected.

Note: There are 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

SIGNS
SYMPTOMS

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.

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.

DIAGNOSIS

NEUROCOGNITIVE BASELINE TESTING

Note: There are 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

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

TREATMENT

Concussion treatment plans are individualized based on the signs and symptoms experienced by the athlete, as well as results of testing performed during the concussion evaluation. Every injury is different, so there is not a single treatment approach that is best for every patient. Treatment options may include rehabilitation exercises, therapy, medications, etc. Sleep is important for recovery and to reduce symptoms.

RETURN TO PLAY
RETURN TO SCHOOL

Clearance by a health professional is strongly recommended, and, in some cases, required by law, the school or 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.

Concussion protocols are typically designed as a one week return to play progression. This is often misinterpreted as the answer to “how long will 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 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.
Symptom-free during/after exercise to progress to next stage.

Return to Play 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.

The injured brain needs to rest, so it may be appropriate for your athlete to modify school and cognitive activity soon after a concussion. If available, a school nurse or athletic trainer should be involved early to help facilitate return to school and sports as they often have additional training in the management of concussion.

A school may consider the following accommodations to help a student athlete:
- Reducing homework and class work
- Postponing tests until the student has recovered
- Providing 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)
- Allowing a student to take frequent breaks in the nurse’s office or alternating a class with a rest
- Permit the athlete to go to the nurse’s office for worsening of symptoms during classes

PREVENTION

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?