A Playbook for Sports Concussion

Matthew McCarthy, MD, a member of the Summit Medical Group Neurosciences Center with a specialty in pediatric neurology and sports neurology, provides an expert perspective and advice by answering some commonly asked questions about sports concussion.

Q. What is a concussion?

A concussion is a temporary brain injury resulting from an impact or trauma with enough force to cause brain movement, leading to abnormal neurological function and a wide range of clinical signs and symptoms. Signs and symptoms of a concussion typically start immediately or soon after the impact and will evolve over hours to days.

Symptoms a concussed athlete may report:

◊ Headache or head pressure                     ◊ Memory problems

◊ Sensitivity to light and/or sound              ◊ Not “feeling right”

◊ Nausea and/or vomiting                          ◊ Feeling tired or fatigued

◊ Balance problems or dizziness                 ◊ Mood changes

◊ Feeling sluggish, foggy, or slowed down

Signs that may be observed after concussion:

◊ Loss of consciousness                 ◊ Confusion or slowed responses

◊ Dazed or stunned look                ◊ Inability to recall events prior to or after the hit

◊ Clumsiness

Q. If I suspect an athlete has sustained a concussion, what should I do?

If there is concern that an athlete has a concussion, it is important to remove them from play immediately. Removal from play does not confirm the diagnosis of concussion, but it is an essential step to avoid the potential risk of further injuries. Concussed athletes who are removed from play immediately, have quicker symptom recovery and return to sports compared to athletes who continue playing after a concussion.

Q. After an athlete with a suspected concussion has been removed from play, do they need to go to the ER?

Most people with a concussion do not need to be seen in the emergency room. Following a suspected injury, they should be observed for the next few hours for signs of a more significant injury. Individuals who are stable or show improvement within 4-6 hours after an injury can be managed at home until an appointment with a physician can be made.

If you notice these symptoms, call 911 or visit an ER/Urgent Care:

◊ Prolonged loss of consciousness

◊ Increasing confusion or irritability

◊ Declining level of consciousness

◊ Seizures

◊ Repeated vomiting

◊ Weakness or numbness

◊ Extreme or unusual behavior changes

◊ Slurred speech

◊ Significant facial or posterior head bruising

◊ An obvious skull fracture or deformity

Q. What can I do to help with symptoms immediately after a concussion?

It is essential to take good care of yourself after a concussion. Drinking plenty of fluids, eating healthy meals, and maintaining a normal sleep pattern in the hours after an injury can help to minimize early symptoms. For treatment of a headache within the first 24 hours, medication should be limited to Acetaminophen (Tylenol), but after that point, other over-the-counter medications can be used (Ibuprofen/Motrin/Advil, Naproxen/Aleve, etc.).

Q. Who should an athlete see for management of his or her concussion?

It is important to be seen by a health care provider with experience in the treatment of all neurological conditions and expertise in concussion management soon after an injury in order to confirm the correct diagnosis and begin appropriate treatment. Ideally, this should be within 24-48 hours of a suspected injury, so seeking an expedited appointment is essential.

Q. What is the best concussion baseline test?

Since there is no single test that can diagnose concussion, there is no single test that has been established as the best concussion baseline. The most important thing to consider before a season is where an athlete would be seen in the event of a suspected concussion. Ideally, the baseline should be conducted with that person or at least ensure that the baseline information collected will be useful to that provider while managing a concussion.

While there are many commercial tests used as part of a concussion baseline, no single test can diagnose a concussion or determine when an athlete is ready to return to play. An ideal baseline should include a comprehensive medical history, neurological exam, and discussion with a physician about concussion diagnosis and management, long-term risks and benefits, and injury prevention and safe play recommendations. Preferably, a baseline should be done every 1-2 years while an athlete is still playing competitively.

Q. How long do I have to rest after a concussion?

There is a brief period following injury, typically 24-48 hours, where significant rest may be beneficial due to a high symptom burden. This period should be guided by how the patient feels and is not necessary for everyone. If an athlete feels comfortable, he or she should be encouraged to continue or gradually resume usual daily activities (excluding sports) as tolerated (including school, homework, chores, use of technology, social activity, and light physical activity) and to use accommodations early on as needed. The old approach of prolonged rest and avoidance of activity until all symptoms are gone is not helpful and is no longer recommended. Concussion should be successfully managed with an individualized active rehabilitation approach from beginning to end.

Q. How long does it take to recover from a concussion?

A concussion should heal completely within a couple of weeks and does not cause any permanent impairment. As the injury is recovering and symptoms are resolving, physicians will provide guidance on a gradual return to sports and other physical activity. With proper management, athletes can return to their usual activities in a safe and timely manner.

Q. How many concussions are too many?

There is no number of concussions that is too many. Every person and every injury is different. Deciding to retire from a sport is a complicated decision that should not be rushed or taken lightly. A comprehensive evaluation and in-depth discussion of all prior injuries, other medical problems, current symptoms and concerns, and long-term risks and benefits of each individual sport are necessary to make an informed decision about continued participation. While our understanding of the long-term risks and benefits of sports participation is continuing to improve, there are still many things we don’t know, and each person needs to be assessed on an individual basis.