One of the most important aspects, if not the most important part of dealing with concussions, is knowing when an athlete can return to their sport. If an athlete is rushed back too early, this can create an increased recovery time, and even put the athlete at risk of further, more severe brain injury.
As mentioned in the previous post, older athletes tend to recover a little quicker than younger athletes. The typical ranges are: adults - 2-3 days; college age - 7-10 days; high school age - 14-21 days; middle school age - 28-35 days. Now these are just averages and may not be exact timetables for every single athlete. There is not enough evidence out there to determine a range for even younger athletes, though you can expect it to be longer than that of middle school aged athletes.
It is important for athletes to avoid all activity in the early stages of recovery, even doing something light like riding a stationary bike to stay in shape can lead to prolonged recovery time. The brain needs time to rest for it to recover the injury.
There are very specific guidelines that have been developed by professionals all over the world when it comes to returning an athlete who had a concussion back to their sport. The Zurich Return to Play Guidelines were agreed upon internationally by experts and are as follows:
If they are symptom-free with daily activities and they have normal neurologic exam but have not returned to baseline on neurocognitive test, they may start to participate in non-contact sport activity
The progressive physical exertion testing can be broken down into several stages as follows:
Second Impact Syndrome
Second Impact Syndrome (SIS) is a catastrophic injury that occurs when someone sustains a second concussion before symptoms from a previous concussion have fully subsided. While this condition is very rare, it is often fatal as it causes severe swelling in the brain. The second impact can occur seconds, minutes, days, or even weeks after the initial concussion and can even be extremely mild to cause these severe effects. This is why it is crucial to sit an athlete out if there is even a tiny suspicion of a possible concussion.
How Many is Too Many?
There is currently not enough research done to have a concrete answer on how many concussions are too many, however as there is more and more research conducted, we may have an answer to that question in the future. There has been some research out there stating that someone who has received one concussion has an increased chance of sustaining a second concussion, but more research needs to be done.
Unfortunately, there is often not much that can be done to prevent concussions from happening. In cheerleading, the most effective prevention tool is proper progression of skills and using proper mat surfaces. If the athletes are not ready for certain skills, this increases the chance of the falling, leading to an increased risk of concussions.
There has been a recent surge in discussion of “concussion-proof helmets”. Research evidence shows that these are ineffective in preventing concussions from occurring. The concussion does not solely occur from a direct blow, but rather the jostling of the brain inside the skull, which is impossible for a helmet to prevent from occurring.
Know your athletes. If you see that they get hit to the head, it is better to be safe and sit them out and be fully assessed then to be put at risk of further injury. A concussion can’t be “seen” like many other injuries, so a proper assessment is needed for diagnosis. Long-term effects are minimal if the concussion is managed properly, but if not, there can be lasting effects that can impact the athlete’s life forever.
Now that you have recognized the symptoms of a concussion in one of your athletes, what is the next step to take? Managing the symptoms of a concussion appropriately is the best thing you can do to get that athlete back into their sport.
Unfortunately, there is no specific cure out there for concussions and managing the symptoms that are present is the treatment of choice. Fortunately, with proper management, the majority of concussions resolve spontaneously with no long-term effects. Some symptoms may take longer to recover from than others. Also, younger athletes tend to take longer to recover than older athletes, which is the opposite trend that we tend to see from musculoskeletal injuries.
Symptoms that take longer to recover from include:
In the early stages after a concussion, the symptoms listed in Part 1 of this series are expected to be present and are normal. However there are some symptoms that may begin to develop over the first few days that are concerning and require immediate medical attention at an emergency department. Symptoms to look out for include the following:
Next we will look at some of the most common symptoms of a concussion and strategies that can be used to help treat these symptoms.
One of the more serious concerns following a concussion is the potential of a brain bleed. While extremely rare following a concussion, it needs to be kept in mind as a bleed is very serious. For the first few days, Tylenol can be used to treat the headaches as it will not impact any potential bleeding. If there are no signs of a bleed after a few days (any of the critical symptoms listed above), the athlete is free to take anti-inflammatory medication to help with the headaches. Some research shows that there is often some inflammation following a concussion, and anti-inflammatory medications can help with this.
On the topic of medications, if an athlete was taking any other prescription medications prior to the injury, they should continue to take those.
How often do you hear that concussed individuals need to be woken up every couple hours when they are sleeping during the first night? If you are concerned enough to feel the need to wake the athlete up every hour or 2 while they are sleeping, they need to go to the emergency department for further testing. Sleep is one of the most important aspects of the initial recovery following a concussion as rest allows the brain to recover from injury.
If the athlete is having trouble sleeping or staying asleep through the night, sleep aides such as melatonin can be used. Taking naps throughout the day as necessary is another way to make sure that the athlete is getting enough sleep each day.
Minimizing exposure to visual and audio stimuli is also important to allow the brain to rest and recover from the injury. Staying away from the following will make daily life more comfortable for the individual:
How Can a Physical Therapist Help?
Most of the remaining common symptoms that we see are things that a physical therapist can help with
Return to School
Some athletes may need to stay home the first few days following the concussion, which is okay and beneficial for recovery. It is important, however, to get them back to normal day-to-day function. Shutting the athlete off from stimulus completely for a prolonged period will make it harder for them to adapt once they return.
Try to arrange for accommodations rather than complete removal from school after the first few days depending on the symptoms they are having (such as having extra time to change classes if there is too much stimulus from other students or having pre-printed notes opposed to having to look at computer or screen)
It is also important to restrict physical exertion during the school day such as physical education class, choir, band, or any other class that will provide too much stimulus for the individual to cope with.
Managing these symptoms early and getting the athlete with a physical therapist will decrease the recovery time and get the athlete back to normal life faster. As mentioned, with proper management of the symptoms, most athletes will fully recover from a concussion.
This is Part II of a 3 part series, Click Here for Part I, Click Here for Part III
The concussion is an injury that is gaining more attention over the past few years, especially with the increase in exposure in the media. It is estimated that concussions account for 8.9% of all high school athletic injuries and about 7% of all sports-related injuries. However, it is likely that the total number of concussions estimated is low due to under-reporting of injuries as many athletes will not seek medical attention following a concussion.
So you had an athlete get a hit to the head during practice. Maybe they were basing a stunt and the flyer came down on their head, or they were tumbling and collided with a teammate. What should you do? One thing about concussions is that not everyone presents the same way. There are many different possible symptoms that can be present, and any one person can have any possible combination of those symptoms.
Mechanism of Injury
2 most common mechanisms of injury (how the injury occurred)
A concussion is not a direct injury to the brain tissue itself, rather a chemical reaction and alterations that cause the symptoms that we typically see.
The most common symptoms to look out for include the following:
If any of these symptoms are present following a blow to the head, it is crucial for the athlete to see a medical professional to be assessed for a concussion. It is imperative that an athlete that is displaying any signs or symptoms of a concussion to sit out for the remainder of the day until they are cleared by a medical professional.
While it is very rare for someone to have every one of these symptoms, it is possible. A common misconception is that someone must lose consciousness for a concussion to take place. It is important to note that less than 10% of concussions are associated with a loss of consciousness. So even if the athlete did not get “knocked out”, they very well may still have a concussion.
Diagnosing a Concussion
The diagnosis of a concussion is typically based on the signs and symptoms that are present, as it will not show up on any type of imaging. MRI and CT scans may be used to detect skull fractures or bleeding in the brain. Physical therapists and athletic trainers are trained in conducting several different tests that can be used to aid in the diagnosis of a concussion.
Many programs and athletic associations have begun to implement baseline concussion testing. What this does is provides the information of an athlete's normal cognitive and physical functioning. So if there is a question of a possible concussion, the same test can be repeated to compare the athlete to their baseline.
A concussion is classified as a mild traumatic brain injury and needs to be treated as such. Many times the symptoms of a concussion do not show up right away and can even take a few hours to a few days to present. This is why it is important to make sure that the athlete is examined by a healthcare professional if there is any suspicion of a possible concussion.
This is Part I of a 3 part series, Click Here for Part 2
Disclaimer: The information contained on this website is compiled from a variety of professional sources as well as the author's own experiences. The information should NOT be used in place of a visit to your healthcare provider or used to disregard any advice provided by your healthcare provider.