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Sport Concussions: “When in doubt, sit them out!”

Every person is different and unique. Every brain is different and unique.  Similarly, every concussion is different and unique.  Sport Concussion continues to be a hot topic today.  Concussion is not a new idea, but we do continue to learn more about the proper diagnosis and treatment of concussions.  I believe important goals of concussion management are to keep athletes safe and also return to school and play in a timely manner.

What causes a concussion? A concussion is often caused by a direct blow to the head, but can also be caused by an indirect blow to the body, which may trigger the concussion. The diagnosis of a sport concussion is a clinical diagnosis only.  In other words, no single test or imaging study will diagnosis it.  A concussion must be diagnosed using a detailed history and physical exam by an experienced clinician.

So what exactly is a sport concussion? There are multiple, yet similar, definitions of concussion. One definition I am fond of is: A concussion is a complex (emphasis on “complex”) pathophysiologic process affecting the brain, which is induced by biomechanical forces. In layman’s terms, a sport concussion is caused by an injury to an athlete’s brain.  Due to this injury, the athlete will then not “feel well.”

What are the signs and symptoms of a concussion? I think it is important to know that only about 5% of athletes will have loss of consciousness (“Black-out”) with a concussion. Also, the presence of a headache does not diagnosis a concussion.  However, headache is found in 70% of concussions.  This headache is usually on the front of the brain, and often worsens with exercise and cognitive (i.e. school work) exertion.  Other common symptoms are: brain fog, slowed thinking, brain fatigue or visual fatigue (“eyes hurt”).  Some urgent signs which need emergent evaluation include: new onset nausea and vomiting, worsening headache, double vision or other neurologic deficits (weakness, numbness, speech difficulty, etc).  To note, this is by no means an all-inclusive list of signs or symptoms of a concussion.

Being that a concussion is sometimes difficult to diagnosis, I prefer to error on the side of safety for our athletes. My advices for coaches and parents out there… when in doubt, sit them out!(…and have the athlete evaluated by a medical professional).  If you think there is even a slight possibility that your athlete or child had a concussion, please take them out of play and have them evaluated by a trusted medical professional in a timely manner.

Finally, how long do concussions last? Most symptoms resolve in 7-10 days. However, some people will take up to a month or longer to heal. Interestingly, new studies are showing most children may take longer than adults for all symptoms to resolve.  This is unique compared to most illness, as children often bounce back from injury/illness quicker than adults. Remember, there is no such thing as a “generic” return to school/play calendar, as every athlete is different. Return to learn should happen before return to play in my opinion.  An athlete should be able to go to school and do homework without much worsening of symptoms before a “return to play” protocol has begun.

When an athlete is ready and cleared for a return to play protocol, expect about 7-10 days of progression. This progression usually starts with basic low impact exercises to get ones heart rate elevated (i.e. stationary cycling), then to a slow increase in sport specific exercises, then to scrimmaging and finally full game play.

I hope you have found this information helpful to address some common questions regarding sport concussions.  Safety should always be our number one concern for our young athletes.  Therefore, my last word of advice about concussion is…”When in doubt, sit them out!”

References:

Evaluation and Management of Concussion in Athletes. https://www.aafp.org/afp/2014/0401/p585.html

Kyle Snell, DO, is a board-certified family medicine physician. Dr. Snell earned his medical degree from Michigan State University College of Osteopathic Medicine in East Lansing. He completed his family medicine residency at Sparrow Hospital in Lansing and his sports medicine fellowship at Michigan State University in East Lansing. Dr. Snell’s clinical interests include sports medicine, preventive medicine and osteopathic manual medicine.