Getting Back to Sports After a Concussion

It can be frightening if you or your child have been diagnosed with a concussion. The potential dangers of these injuries have gotten a lot of attention in recent years because of their potential to cause debilitating brain damage.

Concussions are, indeed, serious matters. But there is little chance for any long-lasting damage – including chronic traumatic encephalopathy (CTE), a condition similar to Alzheimer's disease – if you properly manage the injury and fully recover before getting back into action.

What Is a Concussion?

When you think of concussions, you probably envision someone hitting their head against something hard while falling or getting knocked to the ground. Certainly, that is one of the more common ways for a concussion to occur. But they can also happen without anything touching your head.

These mild traumatic brain injuries can occur when your head suffers a violent shaking or force. Direct impact is commonly seen in sports like football, basketball and soccer. But even sports like gymnastics, diving and cheerleading can create situations where your brain is subjected to the kind of whiplash force that creates a concussion.

Your skull is a hard, protective bone that protects your brain, made of soft tissue. Think of your head as a jar of pickles. If you shake that jar hard, the pickles will be knocked around and damaged by striking the sides of the jar – even if the jar itself remains unharmed.

When a concussion occurs, your brain cell functioning is altered, creating chemical and metabolic changes in your brain. This disruption creates a wide range of symptoms. Among the most common:

• Headache
• Nausea or vomiting
• Confusion
• Temporary loss of consciousness
• Dizziness
• Vision problems (including double vision)
• Difficulty sleeping or staying awake
• Ringing in the ears
• Light and noise sensitivity
• Unexplained tiredness
• Difficulty concentrating
• Unexpected mood changes (including depression, irritability and anxiousness)
• Mental fogginess

Managing a Concussion

Much has changed in the way concussions are treated. Long gone are the days when patients were sequestered in darkened rooms to do nothing more than rest, sleep and avoid stimulation. Instead, the opposite approach is used.

There’s nothing wrong with rest or sleeping – which gives your body time to work on its own healing. But research has shown that progressively vigorous physical and mental activities are key to quicker recovery. Physical activity, in particular, promotes healing by increasing blood flow and oxygen to the brain.

Safely returning to sports activities involves a six-step strategy:

• Stage 1: Limited physical exertion (walking and similar activities) that doesn’t make your symptoms worse.
• Stage 2: Physical exertion is ramped up to include light- to moderate- aerobic exercise (stationary cycling and light resistance training)
• Stage 3: Return to sport-specific exercises, but away from a team environment
• Stage 4: Sport-specific exercises (without contact) can ramp up, in the team environment
• Stage 5: Normal training activities, including full-contact practice (medical clearance is recommended)
• Stage 6: Return to the sport, with medical clearance

There are also mental (school and work) considerations in concussion management. Following a concussion, you or your child may experience light sensitivity and have difficulty reading small print and looking at bright screens. This may require some accommodations during the recovery process.

Students, for example, may need to modify laptop settings (decreasing brightness or enlarging fonts) and be allowed more frequent breaks (every 15-20 minutes) to avoid exacerbating their symptoms.

Concussion Dangers

One of the biggest dangers with concussions – particularly with teenagers – is not reporting symptoms. The odds of getting safely past a concussion are substantially increased when you or your child are honest about symptoms.

You want to avoid further damage to your brain before it has time to heal. In rare instances, a second injury can result in second-impact syndrome. The condition results in rapid brain swelling, which can cause permanent disability or death.

A more likely outcome is that you will aggravate the original injury and significantly increase the time it take to heal. Instead of getting past your symptoms in a week or 10 days, you could be looking at a recovery lasting a month or longer.

Concussion-related symptoms should be reported to a doctor or your child’s coach and certified athletic trainer. It could turn out to be nothing. But if it is a concussion, that’s the best way to make sure it is treated properly.