What is a Concussion?
A concussion is a type of traumatic brain injury caused by a bump, blow, or jolt to the head or by a hit to the body that causes the head and brain to move rapidly back and forth. This sudden movement can cause the brain to bounce around or twist in the skull, creating chemical changes in the brain and sometimes stretching and damaging brain cells. (1)
What are the symptoms of a concussion?
Headache or “pressure” in head.
Nausea or vomiting.
Balance problems or dizziness, or double or blurry vision.
Bothered by light or noise.
Feeling sluggish, hazy, foggy, or groggy.
Confusion, or concentration or memory problems.
Just not “feeling right,” or “feeling down”.
What are the signs of a concussion?
Can’t recall events prior to or after a hit or fall.
Appears dazed or stunned.
Forgets an instruction, is confused about an assignment or position, or is unsure of the game, score, or opponent.
Moves clumsily.
Answers questions slowly.
Loses consciousness (even briefly).
Shows mood, behavior, or personality changes.
Recovery from a Concussion
Most patients with a concussion feel better within a couple of weeks. However for some, symptoms will last for a month or longer. Concussion symptoms may appear during the normal healing process or as you gets back to your regular activities. If there are any symptoms that concern you or are getting worse, be sure to seek medical care as soon as possible.
1. Rest
Patients should take it easy the first few days after the injury when symptoms are more severe.
- Early on, limit physical and thinking/remembering activities to avoid symptoms getting worse.
- Avoid activities that put you at risk for another injury to the head and brain.
- Get a good night’s sleep and take naps during the day as needed.
- Take frequent “Brain Breaks” – 5 to 10 minutes in a dark quiet place with your eyes closed
2. Light Activity
As your child starts to feel better, gradually return to regular (non-strenuous) activities.
- Find relaxing activities at home. Avoid activities that put your child at risk for another injury to the head and brain.
- Return to school gradually. If symptoms do not worsen during an activity, then this activity is OK for your child. If symptoms worsen, cut back on that activity until it is tolerated.
- Get maximum nighttime sleep. (Avoid screen time and loud music before bed, sleep in a dark room, and keep to a fixed bedtime and wake up schedule.)
- Reduce daytime naps or return to a regular daytime nap schedule (as appropriate for their age).
3. Moderate Activity
When symptoms are mild and nearly gone, your child can return to most regular activities.
- Help your child take breaks only if concussion symptoms worsen.
- Return to a regular school schedule.
4. Back to Regular Activity
Recovery from a concussion is when your child is able to do all of their regular activities without experiencing any symptoms.
When should I return to my sports after a concussion?
There have been several return to play protocol’s written. Dr. Kevin Mangum likes the CDC six step return to play progression protocol. Please discuss your individual sport with Dr. Kevin Mangum and he can help individualize your return to play progression.
6-Step Return to Play Progression
It is important for an athlete’s parent(s) and coach(es) to watch for concussion symptoms after each day’s return to play progression activity. An athlete should only move to the next step if they do not have any new symptoms at the current step. If an athlete’s symptoms come back or if he or she gets new symptoms, this is a sign that the athlete is pushing too hard. The athlete should stop these activities and the athlete’s medical provider should be contacted. After more rest and no concussion symptoms, the athlete can start at the previous step.
Step 1: Back to regular activities (such as school)
Athlete is back to their regular activities (such as school) and has the green-light from their healthcare provider to begin the return to play process. An athlete’s return to regular activities involves a stepwise process. It starts with a few days of rest (2-3 days) and is followed by light activity (such as short walks) and moderate activity (such as riding a stationary bike) that do not worsen symptoms.
Step 2: Light aerobic activity
Begin with light aerobic exercise only to increase an athlete’s heart rate. This means about 5 to 10 minutes on an exercise bike, walking, or light jogging. No weight lifting at this point.
Step 3: Moderate activity
Continue with activities to increase an athlete’s heart rate with body or head movement. This includes moderate jogging, brief running, moderate-intensity stationary biking, moderate-intensity weightlifting (less time and/or less weight from their typical routine).
Step 4: Heavy, non-contact activity
Add heavy non-contact physical activity, such as sprinting/running, high-intensity stationary biking, regular weightlifting routine, non-contact sport-specific drills (in 3 planes of movement).
Step 5: Practice & full contact
Young athlete may return to practice and full contact (if appropriate for the sport) in controlled practice.
Step 6: Competition
Young athlete may return to competition.
Handouts
All parents who have children playing sports should have this quick fact sheet about concussions from the CDC.
ACUTE CONCUSSION EVALUATION (ACE) Physician/Clinician Office Version
SCHOOL LETTER Returning to School After a Concussion
Acute Concussion Evaluation (ACE) Care Plan – School Version
Acute Concussion Evaluation (ACE) Care Plan – Work Version
References
American Medical Society for Sports Medicine position statement: concussion in sport
Concussion (Mild Traumatic Brain Injury) and the Team Physician A Consensus Statement—2011 Update
CDC HEADS UP program
Concussion Scoring Tools