By Nathaniel Harlow, DO
March is Brain Injury Awareness Month. Here I provide answers to frequently asked questions about concussion that I hear in the Sports Medicine Clinic at Sharon Health Center.
What is a concussion?
There are many different ideas about what a concussion actually is, but healthcare professionals agree that a concussion is a form of mild traumatic brain injury, or TBI. It is an injury to the brain that results from either a direct impact to the head or rapid acceleration injury (think whiplash injury). In a concussion, there is usually no visible damage to the brain, such as bleeding, but there is damage to the cells, resulting in how brain cells communicate with each other. This includes disrupting common brain functions such as blood flow and sugar uptake.
What are common symptoms of concussion?
Symptoms usually start at the time of the injury but often change in the hours and days after an injury has occurred. Some common symptoms include headache, dizziness, nausea, vomiting, and feeling “foggy” or “dazed.” People also occasionally experience loss of consciousness, amnesia surrounding the event, or seizures. Later, people often also complain of difficulty concentrating, problems with sleep, and even mood changes.
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How common are concussions?
Extremely common! The number of people diagnosed with concussion in the United States has been rapidly rising since the turn of the century. About 1.8 million children and adolescents end up in the Emergency Department each year due to concussion. It is estimated that about 50 percent of concussions in patients under age 18 are related to sports or recreational activities. Concussions are commonly seen in collision sports like football, hockey, lacrosse, and wrestling. They are also very common in contact sports, including soccer, basketball, and field hockey. Concussions also frequently occur outside of organized sports, and in my clinic I frequently see concussions as a result of accidents while skiing, biking, all-terrain vehicle (ATV) riding and dirt biking, and playing on a trampoline.
Will I ever get better?
The good news is that the vast majority of patients who suffer a sports-related concussion recover quickly without any long-term effects. Most adults who suffer a concussion will recover within seven to 14 days. However, it is not uncommon for younger patients to have symptoms for up to four weeks.
How do you treat a concussion?
Concussion research is rapidly growing. However, we still don’t have fantastic evidence for how to treat a concussion. The medical recommendation is that patients should be treated with physical and mental rest. That doesn’t mean living in a cocoon until all the symptoms have resolved, but it does mean taking it easy for a while. It is reasonable to stay out of work or school for a day or two, but then try to ease back into day-to-day life as soon as the patient feels able. Often accommodations can be made to make this easier, such as wearing sunglasses in bright rooms, limiting screen times, postponing big tests, etc.
It is thought that rushing too soon back into high-intensity physical activity or contact sports may be dangerous or make concussive symptoms worse, but more and more evidence suggests that light to moderate cardiovascular exercise may speed up recovery from a head injury. Over-the-counter medications like ibuprofen and acetaminophen are usually safe for most people to treat headaches associated with concussion – if you are not sure ask your doctor! I also always suggest to patients that they try to keep a normal sleep schedule with at least eight or nine hours of sleep a night, eat a healthy diet, stay well hydrated, and avoid drugs and alcohol while their brains are healing.
When can I go back to my sport?
For kids participating in school-sponsored organized sports in Vermont, the answer is easy: “When your symptoms have resolved, when you have a normal examination, when you have returned to school without accommodations, when you are off all medications for concussive symptoms, and when you have completed a graduated return to play protocol.” Basically, this means kids have to work closely with their coaches, trainers, and healthcare providers to be cleared to go back to playing sports.
For adults or kids not involved in organized sports, the answer sometimes is a little more complicated. I typically tell patients that they need to give their brain a chance to heal. I tell them that, at the very least, they should feel like they are “back to normal” and have resumed their usual nonathletic activities first before gradually easing back into their sport or activity of choice. If someone is planning on going back to trail running, I’m not usually as concerned as someone who’s sport of choice is bull riding.
How can I prevent getting another concussion in the future?
Unfortunately, not all concussions and traumatic brain injuries are preventable in sports or day-to-day life. It is important for athletes, coaches and officials to abide by and enforce fair rules of play. Eliminating unnecessary roughness in sports is helpful in decreasing all types of injury. Minimizing contact in youth sports, particularly in hockey, has been shown to significantly decrease the rate of concussion. Teaching kids proper technique in sports is important. Working on neck-strengthening exercises may have a role in helping prevent concussions in certain athletes. Wearing appropriate safety equipment, like helmets, may not decrease the risk of concussions but has been shown in many settings to decrease more devastating injuries like skull fractures and bleeding in the brain.
Outside of the sports world, reducing risk-taking behavior is the most important modifiable factor: maybe don’t try to ride your kid’s skateboard down the hill after a couple of beers; wear your seatbelt; wear your helmet on your ATV; throw some sand on your driveway when it’s icy.
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The Sports Medicine Team at Sharon Health Center is committed to providing athletes of all abilities with specialized care for injuries and illnesses, preventing future injuries, and promoting lifelong fitness and wellness. For more information about the team, visit giffordhealthcare.org/service/sports-medicine.
For more information about concussion and traumatic brain injury, visit cdc.gov.
