The bones of the skull, like an eggshell, protect the brain from objects that may strike it from the outside. Your brain
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UNDERSTANDING YOUR CONDITION:
Concussion
IT’S COMMON to hear about concussions in sports, but the treatment for concussions has changed a lot in the past few years. You should go to a doctor and follow the instructions that are given. With the right approach, most concussions can be healed like any other injury. When recovering from a concussion, the fastest way for you to heal is to limit physical and mental activities. Most concussions can heal with full recovery, while others may lead to more serious injury if not recognized and treated the right way.
What causes a concussion? Think of the brain inside your skull as an egg yolk within its shell. The bones of the skull, like an eggshell, protect the brain from objects that may strike it from the outside. Your brain, like the egg yolk, is cushioned inside the skull by a gel-like fluid that acts as a shock absorber. An impact or violent force that causes the brain to hit the skull bone can injure your brain. An indirect force to the face, neck, or body, like a whiplash injury, can also cause a concussion. A concussion limits the oxygen flow that your brain cells need to work properly. The brain uses a lot of oxygen, and when brain cells are injured during a concussion, blood flow is decreased. The decreased blood flow can damage brain cells, so it’s important that you know the signs of brain injury so you can be safe from further harm.
FORWARD FORCES
BACK WARD FORCES
ROTATIONAL FORCES
What might I expect with a concussion or head injury? Signs and symptoms of a concussion can occur right away or several hours after the injury. Your coaches or parents may notice that you have become confused, don’t know who you are, what you were doing, get clumsy, or have lost your focus. You or your friends, parents, and coaches might even notice a change in your personality, memory, or sleeping patterns. More obvious signs, like vomiting or loss of consciousness, are definite signs of a concussion and that you need to talk to a medical person immediately. Other complaints that you may have include headaches, nausea, dizziness, loss of balance, sensitivity to light or noise, feeling sluggish or fatigued, difficulty concentrating, changes in vision, and fogginess. Be sure to tell your doctor, physical therapist, trainers, or coaches if any of these things happen to you.
EMOTIONAL
MENTAL
PHYSICAL
SLEEP
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Anger Sadness Nervous or anxious Irritability
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Confusion Feeling foggy Poor memory Poor concentration
Headache Clumsiness Dizziness or loss of balance Nausea and vomiting Vision changes
DISCL AIMER: This handout is meant to be used as a general guide only. If you have specific questions, please discuss them with your provider.
Feeling tired Trouble falling asleep Trouble staying awake Too much or too little sleep
UNDERSTANDING YOUR CONDITION: CONCUSSION (continued) How do I know if I’ve had a concussion? Knowing if you have a concussion can be difficult because everyone is affected differently. Imaging tests like a CT scan or MRI are not usually helpful because the test can look normal even when there is injury. 2, 4 A concussion can happen even when someone does not lose consciousness or pass out; less than 10% of diagnosed concussions involve a loss of consciousness.2 Due to the differences in how people are affected, diagnosis is made mostly based on a medical exam and on how your brain is affected.
What should I do? Management of a concussion begins immediately after impact. Continuing to play increases your risk of getting another concussion, which may lead to further injury and longer recovery time. If you think you’ve suffered a concussion and it is not obvious to your coaches or teammates, then you should see a doctor right away. Healthcare providers will rule out head or neck trauma, and may give you a short sideline assessment that tests your memory and attention.2 Afterwards, you may need a follow-up visit with a specialist who will conduct balance and neurocognitive testing (tests of thinking). The main treatments for sports-related concussion is rest and changes in daily activities.2,4,5 Loud music, television, and busy environments should be avoided if these things make your symptoms worse. If you are a student and struggling to perform well in school, talk to your teachers to see if due dates for projects and homework may be extended. You should be excused from gym class and/or extracurricular activities. You need to eat healthy foods and drink plenty of water so the brain can heal.
Path to recovery after a concussion:
1
Removal from play
After a concussion, up to 80% of people will heal within 7-10 days.2 Your recovery depends on not playing sports or doing strenuous activity while your symptoms are still going on. How long you need to take a break from sports or activity is different for each person, and will depend on how quickly the symptoms go away.3,4 Your child or athlete should only return to play once a medically-trained concussion expert decides it’s okay to return.
2
Perform sideline assessment
3
Follow-up with doctor
4
Rest and recovery
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Slow reintroduction of normal activities
6
Return to play upon clearance with a qualified medical professional
How can I avoid a concussion? Not all concussions can be prevented, but some may be avoided by taking certain precautions. At this time, there is no proof that mouth guards and helmets can prevent concussions.2 Helmets will, however, protect you against other serious forms of injury like a skull fracture and are recommended for high-risk sports and activities. You should use safe-play techniques and good sportsmanship, and understand the importance of reporting an injury and symptoms, even if it means stopping play.
Taking precautions like wearing protective equipment during your activities can help protect you from another injury.
Therapy for concussions: Therapists play an important role in helping you get back to your normal routine after a concussion. Following sports concussion, 50% of athletes have reported dizziness, imbalance, and vertigo, and therapists known as vestibular experts are specially trained to help with dizziness and balance difficulties.6 In addition to vestibular therapy, sports physical therapy may also help in the recovery of strength and conditioning necessary for return to play.2,4,9
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DISCL AIMER: This handout is meant to be used as a general guide only. If you have specific questions, please discuss them with your provider.
UNDERSTANDING YOUR CONDITION: CONCUSSION (continued) References: 1.
Ellis MJ, Leddy JJ, Willer B. Physiological, vestibulo-ocular and cervicogenic post-concussion disorders: An evidence-based classification system with directions for treatment. Brain Inj. 2014 Oct 14:1-11. [Epub ahead of print]
2.
McCrory P et al. Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport held in Zurich, November 2012. J Am Coll Surg. 2013; 216(5):e55-71.
3.
Lovell M, Collins M, Bradley J. Return to play following sports-related concussion. Clin Sports Med. 2004;23(3):421-441.
4.
Collins MW, Kontos AP, Reynolds E, Murawski CD, Fu FH. A comprehensive, targeted approach to the clinical care of athletes following sport-related concussion. Knee Surg Sport Traumatol Arthrosc. 2014;22:235-246.
5.
Moser RS, Scatz P, Glenn M, Kollias KE, Iverson GL. Examining prescribed rest as treatment for adolescents who are slow to recover from concussion. Brain Inj. 2015;29(1):58-63.
6.
Kontos AP et al. A revised factor structure for the post-concussion symptom scale: baseline and postconcussion factors. Am J Sports Med. 2012;40(10):2375-84.
7.
Valovich McLeod TC, Hale TD. Vestibular and balance issues following sport-related concussion. Brain Inj. 2014 Oct 7:1-10. [Epub ahead of print]
8.
Alsalaheen B et al. Vestibular rehabilitation for dizziness and balance disorders after concussion. J Neurol Phys Ther. 2010;34:87-93.
9.
Elbin RJ, Schatz P, Lowder HB, Kontos KP. An empirical review of treatment and rehabilitation approaches used in the acute, sub-acute, and chronic phases of recovery following sport-related concussion. Curr Treat Options Neurol. 2014;16:320-332.
10. Harmon KG et al. American Medical Society for Sports Medicine position statement: concussion in sport. Br J Sports Med. 2013;47:15-26.
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DISCL AIMER: This handout is meant to be used as a general guide only. If you have specific questions, please discuss them with your provider.
