A sports-related concussion is a type of traumatic brain injury that occurs when a jolt or blow to the head or body causes the brain to move rapidly inside the skull. This movement can lead to a temporary alteration in brain function. Concussions often occur without loss of consciousness. Proper recognition and management are important for athlete health.
Identifying a Concussion on the Field
Immediate recognition of a potential concussion is the first step in protecting an athlete. Signs and symptoms can manifest right away or develop hours to days after the injury. These indicators are categorized into physical, cognitive, and emotional changes.
Physical symptoms often include headache, dizziness, nausea or vomiting, and problems with balance. An athlete might also experience blurred vision, sensitivity to light or noise, or a feeling of being “slowed down” or “dazed”. Observing unsteadiness on their feet or clumsiness after an impact can also signal a concussion.
Cognitive signs involve confusion, disorientation, or difficulty concentrating. An athlete might struggle to remember recent events or feel like they are “in a fog”. They may also have trouble answering questions or appear to have a blank expression.
Emotional changes can include irritability, sadness, nervousness, or anxiety. The athlete might exhibit inappropriate emotional responses, such as laughing or crying without clear reason, or generally act out of character. If a concussion is suspected, immediately remove the athlete from play.
The Diagnostic Process
After an athlete is removed from play due to a suspected concussion, a healthcare professional conducts a formal diagnosis. This evaluation typically involves a detailed review of the injury, symptoms, and medical history. A neurological examination is performed to assess various functions, including vision, hearing, strength, sensation, balance, coordination, and reflexes.
Healthcare professionals also use cognitive testing to evaluate thinking skills like memory and concentration. Tools like the Sport Concussion Assessment Tool (SCAT) are often used to screen and assess symptoms, providing a structured way to track an athlete’s condition.
Standard neuroimaging studies, such as CT scans or MRIs, are not typically used to diagnose a concussion. Instead, these tests rule out more severe brain injuries like bleeding, significant swelling, or skull fractures, especially if symptoms worsen or are severe. The diagnosis of a concussion is primarily based on clinical judgment, supported by the mechanism of injury and observed symptoms.
Managing Concussion Recovery
Concussion recovery focuses on a period of “relative rest” for both the body and the brain. For the initial 24 to 48 hours after the injury, light daily activities are permitted, such as preparing meals or light walking, as long as they do not significantly worsen symptoms. This approach differs from complete rest in a dark room, which is generally not recommended.
Cognitive rest involves limiting activities that demand significant mental effort. This includes reducing screen time from phones, computers, and televisions, especially in the first 48 hours, as this can contribute to faster recovery. Gradually resuming these activities is advised as symptoms tolerate, avoiding any that cause a notable increase in symptoms.
A gradual return to normal daily cognitive and physical activities is encouraged, with light exercise like stationary cycling or gentle jogging introduced as tolerated. Symptoms should not worsen more than a mild degree, typically 1-2 points on a 10-point scale, and any exacerbation should subside within an hour. Adequate sleep and proper nutrition also play a role in supporting brain healing during this recovery phase.
Structured Return to Play Guidelines
Once an athlete has recovered from their daily activities, a structured “Return to Play” (RTP) protocol guides their re-entry into sports. This multi-stage progression ensures a gradual increase in physical exertion while monitoring for any return of symptoms. Each stage typically lasts at least 24 hours, and progression to the next stage requires remaining symptom-free or with only mild, brief symptom increases that resolve quickly.
The protocol often begins with a structured progression:
- Stage 1: Symptom-limited activity, focusing on daily tasks without exercise.
- Stage 2: Light aerobic exercise, such as walking or stationary cycling, to gently elevate heart rate.
- Stage 3: Sport-specific exercise, like running drills, but without any head impact.
- Stage 4: Non-contact training drills, allowing the athlete to participate in more complex movements and team practices without the risk of head collisions.
- Stage 5: Full contact practice, allowing the athlete to engage in normal training activities.
A qualified healthcare professional must clear an athlete before they advance through these stages and return to full competition, ensuring safety and reducing injury risk.