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concussion advancedIn today’s sports, concussions are part of the game.  Data collected from emergency department visits show:

  • Roughly 300,000 concussions are reported every year.
  • 62% increase (153,375 to 248,418) in nonfatal traumatic brain injuries between 2001 and 2009.
  • 3.8 million reported and unreported sport and recreation related concussions occurring each year in the United States.¹

Why is there an increase in concussions?  

The main reason is that student athletes and parents are better educated on concussions and are now reporting them more than ever. Education is key in minimizing the risk of concussions and ensures proper treatment after sustaining a concussion.

Even with the increase in reporting of concussions, it’s still estimated that at least 25% of concussion sufferers fail to get assessed by medical personnel. New Jersey law requires each school district, charter and non-public school, to develop a written policy describing the prevention and treatment of sports related concussion and other head injuries sustained by interscholastic student athletes.

What is a Concussion and What Causes it?

A concussion is a type of traumatic brain injury (TBI) that causes an alteration in mental status that may or may not involve loss of consciousness.  Concussions are a “shaking” of the brain causing chemical changes as a result of damage to brain cells.  Concussions are caused by a direct or indirect blow to the head.  Examples of a direct blow are heading a soccer ball, helmet to helmet contact, and hitting your head on the ground are just a few examples of direct blows.  An example of an indirect blow to the head would be when you take a hit to the body resulting in a whiplash type force on the head causing the brain to move back and forth in the skull.

What are the Signs and Symptoms of a Concussion?

There are many different signs and symptoms of a concussion.  If your child has one or more of the following symptoms after sustaining a direct or indirect blow to the head, they may have a concussion or a more serious injury. When an athlete shows ANY features of a concussion they should be evaluated by a physician or other licensed healthcare provider.²

Signs and Symptoms of a Concussion Include:

Blurred Vision Dizziness Drowsiness Sleeping More than Usual
Easily Distracted Fatigue Feeling “Foggy” Feeling “Slowed Down”
Headache Nauseous Nervousness Unusual Emotional Irritability
Personality Changes Poor Balance Poor Coordination Loss of Consciousness
Ringing in the Ears “Seeing Stars” Sensitivity to Light Sensitivity to Noise
Sleep Disturbance Vacant Stares Glassy Eyes Vomiting

Concussion Management

Not all concussions present the same set of signs and symptoms from person to person.  The cornerstone of concussion management is physical and cognitive rest until the acute symptoms resolve and then a graded program of exertion prior to medical clearance and return to play.2  Physical rest is important in the acute stages of a concussion.  Returning to physical activity while still symptomatic may exacerbate the symptoms, or worse.  If a concussion has not resolved and you return to soon you are more likely to sustain another concussion or possible catastrophic injury.  Some concussions, depending on severity, require cognitive rest; such as school work, computer work, texting, and video games as examples. Concussions are a case by case assessment and treatment and should be seen as soon as possible to start an immediate treatment plan.

When Can I Go Back to Athletics?

If you have been diagnosed with a concussion you should not return to play (RTP) on the same day.  There are data demonstrating that at the collegiate and high school levels, athletes allowed to RTP on the same day may demonstrate neuropsychological deficits post injury that may not be evident on the sidelines and are more likely to have delayed onset of symptoms.2  In the majority of most states, they have signed into law at the high school level, a graduated RTP protocol after an athlete has sustained a concussion.  This protocol should only be started after given clearance by a physician trained in the treatment and management of concussions. Each step of the protocol should be separated by 24 hours and monitored by your schools Certified Athletic Trainer.  If during these steps, symptoms of the concussion return you should stop with that step and wait 24 hours of being asymptomatic and drop back to the previous step.  Below is a table of the RTP guidelines.2

Rehabilitation Stage Functional exercise at each stage Objective of each stage
1. No activity Symptom limited physical and cognitive rest Recovery
2. Light Aerobic exercise Walking swimming or stationary cycling keeping intensity < 70% maximum permitted heart rate.No resistance training Increase heart rate
3. Sport-Specific exercise Skating drills in ice hockey, running drills in soccer. NO head ImPACT activities Add Movement
4. Non-contact training drills Progression to more complex training drills, eg, passing drills in football and ice hockey. May start progressive resistance training Exercise, coordination and cognitive load
5. Full-contact practice Following medical clearance participate in normal training activities Restore confidence and assess functional skills by coaching staff
6. Return to play Normal game play

Concussion FAQs

A concussion is a brain injury that results from trauma to the head. It can be the result of a fall, collision, sudden change in direction of the head and involves altered brain function.

Not all concussions result in the loss of consciousness. That’s why it is extremely important to be aware of other telling symptoms. These include:

  • Headaches
  • Nausea or vomiting
  • Dizziness or lightheadedness
  • Exhaustion
  • Sensitivity to light and sound
  • Feeling foggy or confused
  • Difficulty with memory
  • Interrupted of changed sleep patterns
  • Drastic emotional changes
  • Poor school performance
A medical professional will determine the diagnosis of a concussion. The concussion must first be reported when concussion-type symptoms become evident. These may be noticed by a coach or athletic trainer. Sideline testing may show signs of confusion or memory loss. Computer-based testing will be used to evaluate changes in brain functioning.
If a concussion is suspected, the injured player should immediately be removed from the activity and should not return until a full evaluation has been conducted by a medical professional. The injury should be reported to an athletic trainer or coach. An immediate emergency evaluation may be necessary if worsening headaches, vomiting, drowsiness, confusion, or any other concerning symptoms. A medical professional may also develop and treatment plan.
Many concussions will heal with time and rest. It is important to not only physically rest, but to also rest your mind by avoiding excessive reading or studying. Specialized treatment is available for injuries that take longer to heal.
Recovery varies depending on the severity of the concussion. Symptoms may last anywhere from hours to many months. Failing to rest or suffer another injury can cause complications which may lead to prolonged symptoms or even permanent injury. It is important to remember that all patients are different and may heal at different times.

Before retuning to play it is important to follow these steps and any instruction from your doctor to avoid further damage or injury:

  • Evaluation by medical professional to diagnose concussion and rule out more serious conditions
  • Rest until symptoms completely resolve
  • Computer-based testing (ImPACT, etc.) shows return to baseline (if available) or to expected level of functioning for age, etc.
  • Progression (gradual increase in physical activity) over the course of 4-5 days under the guidance of athletic trainer or trained medical professional

Only return to full participation once these steps are completed without return of concussion-type symptoms, and final clearance by a physician.

Failure to treat a concussion can cause complications which can include permanent disabilities and even death. Possible long-term mental and/or psychological problems are also possible if poorly treated or neglected.

ImPACT, and other similar programs, are computer-based concussion evaluation programs. Many athletes take this test to provide a baseline to compare to if the athlete suffers an injury. ImPACT is used to measure verbal and visual memory, processing speed, and reaction time in order to evaluate brain function.  These functions are often significantly affected in those with concussions. This test can also be used to help diagnose concussions if the diagnosis is unclear, and to help determine when an athlete’s brain has returned to full function after an injury.

If you think you may have a concussion please contact our office to schedule an appointment today.

¹ Borglio S, Cantu R, Gioia G, Guskiewicz K, et al National Athletic Trainers’ Association Position Statement: Management of Sport Concussion. J of Athletic Training . 2014;49(2):245-265

² McCrory P, et al. Consensus statement on concussion in sport: the 4th International Conference on Concutssion held in Zurich, November 2012.  Br J Sports Med 2013;47;250-258