Concussion Management

Let’s talk concussions.

Did you know that each year U.S. emergency departments treat an estimated 135,000 sports-related and recreational traumatic brain injuries, including concussions, among children ages 5 to 18?  Children and teens are more likely to get a concussion and take longer to recover than adults. Also, athletes who have ever had a concussion are at increased risk for another concussion (Center for Disease Control and Prevention).

A concussion is a type of traumatic brain injury, or TBI, caused by a bump, blow, or jolt to the head that can change the way your brain functions. Concussions can also occur from a blow to the body that causes the brain inside the skull to shake.  

The alarming fact, according to a study from Hasbro Children’s Hospital, is that concussion related visits by organized sports athletes to the emergency room have almost double in the last 10 years, with football and ice hockey leading the way. The good news is that awareness has also increased, and we hear about the topic of concussions on an almost daily basis. Awareness and education are key for a condition that is not only hard to prevent but also difficult to diagnose. 

If a concussion is suspected look for the following signs and symptoms:

• Headache or a feeling of pressure in the head
• Temporary loss of consciousness
• Confusion or feeling as if in a fog
• Amnesia surrounding the traumatic event
• Dizziness or "seeing stars"
• Ringing in the ears
• Nausea or vomiting
• Slurred speech
• Fatigue

Some symptoms of concussions may be immediate or delayed in onset by hours or days after injury, such as:

• Concentration and memory complaints
• Irritability and other personality changes
• Sensitivity to light and noise
• Sleep disturbances
• Psychological adjustment problems and depression
• Disorders of taste and smell

What to do?

The first thing to do when a concussion is suspected is to rule out a more serious injury such as brain bleeding. Seek immediate care if the following is present after a head injury:

• Vomiting
• A headache that gets worse over time
• Changes in behavior, including irritability or fussiness
• Changes in physical coordination, including stumbling or clumsiness
• Confusion or disorientation
• Slurred speech or other changes in speech
• Vision or eye disturbances, including pupils that are bigger than normal (dilated pupils) or pupils of unequal sizes
• Changes in breathing patterns
• Lasting or recurrent dizziness
• Blood or fluid discharge from the nose or ears

Managing a concussion:

If a concussion is suspected, the athlete should be removed from the activity and not be allowed to return the same day. Medical personnel should then evaluate the athlete before returning to any physical, and some times academic, activity. The athlete must then be asymptomatic, both at rest and with activity, before being cleared to return to any sports. An exertional test (a series of sprints, push ups, and jumping jacks used to raise the athlete’s blood pressure) is recommended to see if any symptoms are elicited by exercise. In the event that symptoms return with an exertional test, the athlete should continue to rest until symptoms go away and then try the test again. If no symptoms return with the exertional test, a gradual return to sports is recommended, starting with isolated fitness and moving to sport-specific drills and contact drills. The athlete should be able to complete these activities symptoms-free before fully returning to sports participation. 

In addition, and if available, post-injury cognitive testing like ImPACT should be administered to compare with baseline scores. This is a key element that adds objective information and allows for better management of a concussion. 

Evidence exists indicating that people who have had multiple concussions over the course of their lives may acquire lasting cognitive impairment that limits functional ability.

Why you should never return to your sport while still dealing with the signs and symptoms of a concussion?

One reason, Second Impact Syndrome! SIS

Second Impact Syndrome is a condition in which the brain swells rapidly after a person suffers a second concussion before symptoms from an earlier one have resolved. This second blow may occur days, weeks, or minutes after an initial concussion, and even the mildest grade of concussion can lead to SIS. The condition is often fatal, and almost everyone who is not killed is severely disabled. 

So, make sure that if you suspect you have a concussion, you report it right away. It is better to miss one game than the rest of your life. You can play a soccer game with a sprained ankle. Can you play the game of life with a sprained brain? 

Written by Zack Delgado, ATC

For more information or to make an appointment for the ImPACT (Immediate Post-concussion Assessment and Cognitive Test), please email or call Zack Delgado, ATC – Director of Concussion Management Program @ zdelgado@mostsportsmedicine.com / 301-588-7888 x220