Concussion – also known as a mild traumatic brain injury – is one of the most commonly encountered sports injuries. It can also occur as a result of an accident, such as a fall or a car accident. True concussion 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.
Although it was previously felt that concussions were under-reported, especially among athletes, it is likely that increased awareness has led most athletes, coaches and parents to understand the potentially serious nature of these injuries. This heightened awareness is a positive trend, but there has also been confusing and 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 may have experienced an injury that leads to a concussion.
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 brain. Concussion is most common in contact sports but may also occur outside of sports, such as in a tumbling fall or other accidental collision. It is a fairly common result of whiplash.
Although helmets and sports equipment can prevent skull fractures and more serious traumatic brain injuries, there is no conclusive evidence that they completely prevent concussion. This includes all type of helmets, both hard (football, hockey, etc.) and soft helmets as well as headbands used in sports like soccer.
If you are an athlete who participates in contact sports, your best defense against concussion is to wear appropriate equipment that fits properly and focus on using safe sports techniques.
Signs & Symptoms
If you suspect that you or a loved one has experienced a concussion, it is important that you see a concussion specialist right away for an expert evaluation.
You don’t have to be knocked unconscious 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 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 develop. Symptoms of a concussion may include the following:
- Sensitivity to light
- Sensitivity to noise
- Balance problems
- Visual problems
- Stunned appearance
- Feeling mentally “foggy” or slowed down
- Confusion about recent events
- Having difficulty concentrating
- Responding slowly to questions
- Being forgetful of recent information and conversations
- Repeating questions
- Feeling more emotional than normal
- Sleeping more than usual
- Frequent awakening
- Difficulty falling asleep
- Sleeping less than usual
Most of these symptoms will resolve within a few weeks.
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
When an athlete has an injury that may be a concussion, it is very important to remove them from practice or competition and have them evaluated as soon as possible by a qualified medical professional, ideally someone with experience in concussion management.
Diagnosing a concussion can be difficult, as the signs are often hard to see and other injuries may have similar signs and symptoms. Unfortunately, no single test is accurate in diagnosing concussions. Your healthcare provider will use the history of the injury, symptoms you are experiencing, and a physical exam to try to determine if a concussion has occurred.
In many cases the diagnosis may not be completely clear, but because of the seriousness of concussions, your provider will likely have you take precautions to prevent further injury.
Most of the time, a person with a suspected concussion does not need additional testing. Concussion injuries do not show up on CT Scans or MRI, and these tests are used to diagnose more serious structural injuries to the brain, such as bleeding and swelling. They should only be used when your healthcare provider finds an abnormality that may be a sign of one of these injuries.
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:
- Limited screen time. It is not necessary to completely avoid screen activity (computers, phone, etc.), but screen time should be limited if it worsens your symptoms.
- Light activity. Light activity and exercise may actually help improve recovery, but athletes should not do activities that significantly worsen symptoms.
- Lots of sleep. Get plenty of uninterrupted sleep (after an initial observation period).
- The right medications. Over-the-counter medications such as acetaminophen or ibuprofen may help with headache; however, there is no evidence that supplements such as fish oil have a beneficial effect. If you take a regularly prescribed medication, you do not need to stop unless your provider tells you to.
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 Activities
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.
There are no specific guidelines regarding taking time off school following a concussion, so your doctor will make a recommendation based on your specific 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
Once an athlete has recovered from the symptoms caused by the concussion, a progressive return to sports can begin. This typically involves increasing the intensity and volume of activity over several days. Return to sports (full practice and competition) will vary based on the athlete, age and sport but can range from five to seven days or longer once the athlete starts the process.
If symptoms last longer than 10 to 12 days, exercise may be used as a treatment for the concussion. In this case, athletes may start a therapeutic exercise program as part of their treatment plan. You doctor will also look for additional injuries, i.e., whiplash, that may be contributing to your symptoms.
The long-term effects of concussion are unclear, though there has been a lot of media attention given to the possible connection between concussion and a condition called chronic traumatic encephalopathy (CTE), a progressive neurodegenerative disease.
Scientific research is being conducted to understand CTE better and determine how it may be related to brain trauma, but that research is still in the early stages. Currently, no research links youth contact sports participation with a risk for CTE, and to date, there have been no reports of CTE in young children.
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