If you or a loved one has a concussion, it can be frightening and confusing. While there has been heightened awareness of the danger of concussion, there has also been conflicting advice about how to diagnose and treat this kind of injury to the brain. That’s why the Vermont Orthopaedic Clinic created a dedicated Concussion Clinic. Our goal is to provide expert treatment for individuals who have experienced an injury leading to concussion.
Concussion – also known as a mild traumatic brain injury – is one of the most commonly encountered sports injuries. It results in temporary changes to a person’s normal behavior and physical and mental function. Studies vary, but it is estimated that 2 million sports-related concussions occur each year in the United States.
A concussion is defined as an injury caused by a sudden blow to the head. This injury may not necessarily involve visible or easily diagnosed damage to the head and/or brain. Concussion is most common in contact sports but may also occur outside of sports, such as a in a tumbling fall or other accidental collision.
Although helmets and sports equipment can prevent skull fractures and more serious traumatic brain injuries, they are not able to completely prevent concussion. If you are an athlete who participates in contact sports, your best defense against concussion is to wear appropriate equipment that fits properly and to use safe sports techniques.
Signs & Symptoms
You don’t have to be knocked unconscious in order to have a concussion. In fact, this only occurs in about 10 percent of concussions. Concussions can be accompanied by a range of symptoms that usually last 6-12 weeks or longer and may affect your physical well-being, mental function, emotions and ability to sleep.
Some physical symptoms of a concussion, such as disorientation, confusion, dizziness, and balance or visual problems may be noticeable immediately following the injury. Other symptoms may take longer to show up. Symptoms of a concussion may include:
- Sensitivity to light
- Sensitivity to noise
- Balance problems
- Visual problems
- Stunned appearance
- Feeling mentally “foggy” or slowed down
- Confused about recent events
- Difficulty concentrating
- Slow response to questions
- Forgetful of recent information and conversations
- Repeating questions
- More emotional than normal
- Sleeping less than usual
- Frequent wakening
- Difficulty falling asleep
- Sleeping more than usual
If symptoms last longer than expected, you may have a condition called post-concussive syndrome, which means that symptoms of your concussion may last for weeks or months after your injury.
Diagnosis & Evaluation
The Concussion Clinic at VOC offers the region’s best concussion care, even before injuries occur. Our staff conducts preseason evaluations for athletes who participate in contact sports to gather information about medical history and previous concussions, to test balance and to develop an emergency action plan should an injury occur.
If you think that you or a loved one may have experienced a concussion, it is critical that you seek medical care right away. The expert team at the VOC Concussion Clinic will conduct a thorough evaluation that focuses on your medical history, symptoms, balance and physical condition. Previous concussions, gender, age, type of sport played and other factors will be taken into consideration during your evaluation.
Unfortunately, there is no single test or exam – except loss of consciousness – that can diagnose a concussion. Although not definitive tests, our specialists offer computerized neuropsychological testing and balance assessments that can be used in preseason or return-to-play evaluations. Our specialists generally do not perform CT or MRI scans unless they are concerned about a more significant injury.
Concussions are complex injuries that must be treated individually. If you or a loved one is suspected of having a concussion, the first step is to immediately stop performing the activity that caused the injury and get an evaluation from a qualified medical professional.
The best treatment for concussion is to allow your brain to heal itself over time. Our team offers a number of supportive treatments focused on specific symptoms to help you feel better and safely resume normal activities. Depending on your symptoms, your treatment plan may include:
- Resting until symptoms go away (or for at least the first few weeks)
- Getting plenty of uninterrupted sleep (after an initial observation period)
- Cognitive rest, which means limiting reading, television, texting and most classwork
- Over-the-counter medications such as acetaminophen or ibuprofen, if needed
- Using massage, ice and other comfort measures to treat pain
- Keeping the environment dim and quiet to treat headaches and sensitivity to light or noise
- Prescription medications to treat mood or balance problems
- Physical or occupational therapy to help you regain function, reduce pain or treat balance disorders
If you are diagnosed with concussion, you should avoid medications that may cause drowsiness or that affect the central nervous system, such as stimulants, certain antinausea medications and antidepressants. You should also avoid any activities or environmental conditions that make your symptoms worse.
If you are suffering from post-concussive syndrome, our team of providers will work with you to develop a treatment plan that incorporates carefully monitored exercise, therapy to improve balance, coordination and sport-specific skills, and speech or occupational therapy to assist with specific problems.
Return to Activity
Because each concussion is different and requires customized treatment, your doctor will work closely with you to determine when it is safe for you to return to your normal activities. Although you may be able to return to work or school fairly quickly, your doctor may advise you to wait longer before returning to sports, driving or physical activity, depending on the severity of your symptoms.
- Return to School
- There are no specific guidelines regarding taking time off school following a concussion, so your doctor will make a recommendation based on your individual symptoms. If you have not returned to your normal academic levels after your concussion, you doctor may restrict participation in sports or physical activity. If you develop increased symptoms with cognitive stress, your doctor may recommend a modified class schedule, extended test-taking time, days off or a shortened school day.
- Return to Physical Activity
- To ensure your safety, it is important that you wait until you have made a full recovery before returning to sports or physical activity. Returning to physical activity or sports too soon could increase your risk of suffering from second impact syndrome, or a second, more severe concussion with longer-lasting symptoms. Your doctor may order a neurological exam, which includes a cognitive and balance evaluation, to confirm that you are healthy or recommend that you gradually return to physical activity under medical supervision.
Although there is much to learn about the long-term effects of concussion, studies have shown a connection between concussion and a condition called chronic traumatic encephalopathy, a progressive neurodegenerative disease. Because of its link to professional athletes, this condition has become highly publicized. Fortunately, most young athletes or recreational sports participants are not at risk of developing this condition.
Our sports medicine providers and athletic trainers are available 24/7 through our sports injury hotline. We provide pre-examination advice and offer expedited office evaluations as needed. Our hotline can be reached at 802.236.4117.
For additional information on concussion, please consult the following resources:
NCAA Concussion Program
CDC Concussion Education⁄Heads Up
NFL Health and Safety