Concussions call for a time out

Concussions have made headlines this season. As a physician specializing in sports medicine, I treat many high school and college athletes, youth athletes and weekend warriors, recovering from concussions.

Never ignore a head injury. Get evaluated by a medical provider so you can get back to school and sports more quickly. It’s important to rest and take it easy the first few days after a concussion. By limiting physical and mental activities, you can prevent symptoms from worsening. 

I’m a big believer in the motto of the National Collegiate Athletic Association (NCAA): “It’s better to miss one game than a whole season.” When athletes return to the game too soon, not only do they risk a worse injury or longer recovery, but it also affects performance in sports and academics.  A concussion can affect balance, reaction time, and concentration, to name a few things.

A concussion is a traumatic brain injury (TBI) 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. Coaches and athletic trainers are watching for injuries that can result in concussion. When an athlete is injured, sideline tests can be performed to look for signs and symptoms 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

• 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”.

While an athlete might seem fine right after the injury, it’s important to watch for signs and symptoms for a few days. Pay attention if your child tells you they “don’t feel right” the next morning.

Following concussion protocol to return to school and play is very important because we are talking about the health of your brain. Concussion protocols help with diagnosis, monitor and assist with recovery, improve treatment and prevent worse injury.

In concussion recovery, return to learn comes before return to play. Studies have shown some light aerobic exercise like walking, jogging, or riding a stationary bike can be beneficial to recovery. That’s why we often recommend light aerobic activity early on.  

After 1-3 days of rest, your medical provider and athletic trainer can monitor your symptoms as you return to school and regular activities. In the coming days and under medical supervision, athletes can add moderate activity, heavy non-contact activity, practice and full contact and finally competition once symptoms have resolved.

In Minnesota, athletic trainers working in the schools, can monitor concussions, follow the protocol of the Minnesota State High School League, and clear students to play.

Athletic trainers are often unsung heroes, but they can’t be with every team, in every sport, at every school. I believe in teamwork for concussion recovery. The best care model involves athletic trainers and physicians working together.  The care team can often include more players: physical therapy, occupational therapy, speech therapy and mental health therapists. 

The brain is responsible for many things, so a concussion can affect us in many different ways. It’s not just headaches.  It includes cognitive abilities, sleep, emotional regulation, balance, vestibular system, and ocular system. All of these areas should be assessed.  Every person and every injury is different.  Following a protocol gives us a way to assess and address all these areas. We keep all these things in mind in combination with current medical evidence and guidelines when we make decisions on returning to activities.

One tool used for cognitive abilities is ImPACT software. The Mankato Clinic Foundation and The Orthopaedic and Fracture Clinic provide funding to make ImPACT available in local schools and youth sports leagues. Athletes take a computerized test – similar to a video game – to get a baseline of brain function, memory, processing speed and reaction time. When athletes have a concussion, they take a post-injury test. To be cleared to play, athletes must be symptom free and back to baseline on the ImPACT test.

For high school students and adults, more than half will return to play within two weeks.  It can take longer for younger athletes and athletes over 40.  Still, overall 80-90% will return to sport by 4 weeks, which is still considered a “normal recovery” time.

Your brain needs time to heal after a concussion. While it is still healing, you are more likely to have a repeat concussion or worse injury. A severe brain injury can change your life forever. So take the time to heal.