Concussions in Sports

 Originally published in BN Sports Print Publication BVM Sports - One Place All Sports

By Alissa Recker, PT, DPT, OCS of McLean County Orthopedics

According to the Center of Disease Control (CDC), it is estimated that between 1.6 million to 3.8 million people experience a concussion annually while playing recreational activities and 9% of all high school sports injuries are concussions. A concussion is more than just a headache after an impact to the head. This injury is actually classified as a mild traumatic brain injury and can present with a variety of symptoms. It is important that it is properly medically managed with a multidisciplinary approach, including several healthcare professionals of various backgrounds to ensure a full recovery.

A concussion is defined by the CDC as a "complex pathophysiological process affecting the brain induced by traumatic biomechanical forces secondary to direct or indirect forces to the head." A common misconception is that concussions typically result in loss of consciousness. However, only 10% of people diagnosed with concussions will experience a loss of consciousness. Signs and symptoms of a concussion can present in a variety of ways. Many will experience headaches, difficulty concentrating, fatigue, dizziness, increased sensitivity to light, balance deficits, visual impairments, and/or difficulty remembering and recalling events or information.

Because a concussion is a metabolic cascade of events, rather than structural damage to the brain that causes the injury, it is not likely to show up on any diagnostic imaging studies such as a MRI or CT scan. Instead, concussions are diagnosed using a series of tests that assess your coordination, memory, balance, and visual function. Symptoms may appear immediately following impact to the head, or they may take minutes to several hours to manifest. It is common for symptoms to worsen 24-48 hours following the injury, so it is important to monitor your symptoms and consult your healthcare team if symptoms worsen or new symptoms develop.

Once diagnosed with a concussion, you will need to take time away from your sport to fully re cove r. If you return to your sport too soon and suffer a second concussion before the original concussion is fully healed, there is a significant increased risk of further injury and potentially even permanent brain da mage . This is known as second-impact syndrome. Many factors have a role in length of recovery, such as age, gender, and history of previous concussions. Professional and collegiate athletes typically recover in seven days, whereas the average high school athlete will recover in 14-21 days, and it may take middle school athletes between 28-35 days to make a full recovery.

Female athletes are twice as likely to suffer a concussion in comparison to males playing the same sport. Research also shows females present with more symptoms, including a greater cognitive decline resulting in the likelihood of increased recovery time. Athletes that have suffered three or more previous concussions may report increased symptoms and perform worse on the cognitive diagnostic assessments. In addition, these athletes may be at an increased risk for concussions in the future.

Although the athlete will need time off the court or field to avoid a second impact to the head, it is important that they participate in a progressive active recovery instead of complete rest. A physical therapist can help guide this recovery and collaborate with physicians, athletic trainers, coaches, teachers, and parents to guide the athlete to a full return to sport and academic activity. Previous guidelines for the post-concussive athlete recommended complete rest and decreased brain stimulation until the athlete was completely asymptomatic. However, recent updates to these guidelines recommend an initial period of rest in the acute stage-24-48 hours immediately following the injury-with a gradual increase in activity that does not cause an increase in symptoms.

Research shows that athletes who participated in high levels of activity after concussion reported an increase in symptoms, decrease in cognitive performance, and increase in recovery time. Meanwhile, athletes who participated in moderate activity levels at an intensity that did not reproduce or increase any symptoms demonstrated the best performance and actually facilitated the recovery process. Passive recovery tends not to be actual recovery. Concussion symptoms and problems, such as decreased reactions and balance, continue without specific training through injury rehab. This is where a physical therapist is an important member of the healthcare team and will facilitate a program that may consist of progressive cardiovascular activity, balance, and visual motor training based on the athlete's symptoms and deficits to aide in recovery.

If you have had a concussion or you are interested in pre-season screenings, please contact McLean County Orthopedics Physical Therapy Department at 309-663-6567.